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UNITED  STATES  RAILROAD  ADMINISTRATION 

DIRECTOR  GENERAL  OF  RAILROADS 


SURVEY  AND  RECOMMENDATIONS 

OF  THE  COMMITTEE  ON  HEALTH 

AND  MEDICAL  RELIEF 


DIVISION  OF  OPERATION 


WASHINGTON 
GOVERNMENT  PRINTING  OFFICE 

I  'J20 


UNITED  STATES  RAILROAD  ADMINISTRATION 

DIRECTOR  GENERA.L  OF  RAILROADS 


SURVEY  AND  RECOMMENDATIONS 

OF  THE  COMMITTEE  ON  HEALTH 

AND  MEDICAL  RELIEF 


DIVISION  OF  OPERATION 


WASHINGTON 

GOVERNMENT  PRINTING  OFFICE 

1920 


\ju^3 


CONTENTS. 

Page. 

Preface 5 

Introduction 7 

Exhibit  A. — Letter  submitting  recommendations  to  Director  Division  of  Operation 8 

B. — Chart  showing  comments  of  all  regional  directors,  also  Federal  managers  Southwestern  Region,  on  program  of  committee.  9 

C. — Charts  containing  data  secured  from  the  various  railroads  by  questionnaires 19 

D. — Railway  sanitary  code 66 

E. — General  and  departmental  rules  governing  physical  examinations  of  applicants  for  employment,  promotion,  and  periodic 

examination  in  order  to  determine  their  fitness  for  service 75 

F. — Sm'vey  and  recommendations  for  assisting  in  the  control  of  malarial  fever 79 

G. — Separation  of  claims  and  surgical  departments • - 80 

H. — Granted  trip  transportation  for  local  siu'geons 80 

I. — Sm'vey  of  inspection  of  rest  houses  with  recommendations 80 

,T. — Sm'vey  and  recommendations  regarding  practice  of  laymen  being  used  to  make  vision,  hearing,  and  color  examinations  of 

raihoad  employees 81 

K. — Model  first-aid  kit,  with  directions  for  its  use  and  maintenance  and  estimate  of  cost 82 

3 


PREFACE, 


The  following  report  of  the  Committee  on  Health  and  Medical  Relief  of  the  United  States  Railroad 
Administration  is  recommended  for  the  most  earnest  consideration  of  railroad  officers  and  of  Federal  and  State 
public  officials  in  so  far  as  such  officers  and  officials  have  to  do  with  the  standard  of  health  and  sanitary  regula- 
tions applying  to  railroads.  This  committee  has  been  at  work  since  September.  1918,  and  has  labored  diligently 
to  improve  health  and  sanitary  conditions  on  the  railroads  of  the  United  States.     Its  conclusions  are  the  result 

of  long  study  and  a  most  comprehensive  survey  of  the  problem. 

Walker  D.  Hines, 

Director  General  of  Railroads. 
5 


INTRODUCTION 


September  25,  1918,  the  Director  General  of  Ilail- 
roads  issued  the  following  circular: 

The  Committee  on  Health  and  Medical  Relipf 
for  the  United  States  Railroad  Administration  is 
hereby  appointed,  consisting  of  the  following: 
Dr.  D.  Z.  Dunott,  Chairman. 
Dr.  G.  W.  Cale,  jr. 
Dr.  Victor  G.  Heiser. 
Dr.  T.  R.  Crowder. 
Dr.  H.  M.  Bracken. 
The    committee    will    establish    an    office    in 
Washington  and  will  conduct  a  survey  of,  and 
submit    recommendations    in    connection    with, 
the  proper  protection  of  the  health  of  employees 
and  patrons  of  the  railroads  under  Federal  control. 
W.  G.  McAdoo. 
Director  General  of  Railroads. 

The  committee  established  an  office  in  Washington, 
D.  C,  but  was  unable  to  begin  active  work  before 
the  latter  part  of  November,  1918,  due  to  the  preva- 
lence of  influenza  over  the  country,  the  members  of 
the  committee  being  engaged  in  the  work  of  combat- 
ing this  terrible  scourge. 

Since  November  22,  1918,  the  conunittee  has  held 
frequent  meetings;  has  had  referred  to  it  through  the 
Bureau  for  Suggestions  and  Complaints  a  large  num- 
ber of  complaints  received  from  the  general  public 
concerning  the  insanitary  condition  of  stations,  cars, 
shops,  and  toilets;  this  gave  an  excellent  opportunity 
to  investigate  the  conditions  which  patrons  of  rail- 
roads complained  of,  and  we  were  able  in  many 
instances  to  suggest  a  remedy;  also  handled  a  num- 
ber of  health  conditions  that  confronted  the  Raili'oad 
Administration  to  a  satisfactory  conclusion;  and  re- 
ported from  time  to  time  upon  ciuestions  submitted 
to  it  bv  the  Jiailroad  Administration. 


In  order  to  familiarize  itself  with  railroad  condi- 
tions in  so  far  as  they  applied,  committee  made  sur- 
veys through  questionnaires  sent  to  all  railroads  under 
Federal  control,  and  inspected  railroad  sanitary  and 
health  conditions  in  32  States.  Upon  knowledge 
gained  during  these  inspections  and  data  procured 
through  questionnaires,  committee  has  based  its  rec- 
ommendations. 

The  committee  recognizes  that  probably  its  Ijest 
service  is  along  the  line  of  preventive  medicine  and 
preventive  surgery,  which  offers  opportunitj^  not  only 
for' humanitarian  eft'ort  but  will  make  possible  greater 
efficiency  and  lessened  cost  in  operation.  Typhoid 
fever,  smallpox,  malaria,  and  hookworm  are  pre- 
ventable from  a  practical  standpoint,  m  fact  the  con- 
tinuation of  these  diseases  should  not  be  tolerated. 
Reconstruction  siu-gery  is  ui  its  infancy,  oj^ening  up 
a  great  field  for  researcli  and  betterment  in  the  care 
of  the  injured. 

The  medical  and  surgical  departments  connected 
with  the  railroads  offer  imusual  opportunity  for  the 
disseminating  of  information  on  these  several  sub- 
jects. 

The  committee  aclviiowledges  its  appreciation  of  the 
hearty  cooperation  and  supjiort  of  the  central  rail- 
road administration,  the  regional  directors,  Federal 
managers,  and  other  railroad  officials  with  whom  we 
came  in  contact. 

Dr.  D-.  Z.  DuNOTT,  Chairman. 

Dr.  G.  W.  Cai.e,  Jr. 

Dr.  Victor  G.  Heisek. 

Dr.  T.  R.  Crowder. 

Dr.  H.  M.  Bracken. 

Dr.  T.  R.  Payne,  Secretary. 


Exhibit  A. 


August  19,   1919. 
Mr.  W.  T   Tyler, 

Director  Division  of  Oferation, 

Washington,  D.  C. 

Dear  Sir:  The  undersigned  Committee  on  Healtli 
and  Medical  Relief  was  appointed  September  25,  1918, 
for  the  purpose  of  conducting  a  survey  of,  and  sub- 
mitting recommendations  in  connection  with,  the 
proper  protection  of  the  health  of  employees  and 
patrons  of  the  railroads  under  Federal  control. 

On  account  of  the  influenza  epidemic  it  was  not 
possible  for  the  committee  to  hold  its  first  meeting 
until  November  22, 1918;  since  that  time  thecommittee 
has  held  frequent  meetings  and  has  made  investiga- 
tions and  reported  from  time  to  time  upon  the 
questions  submitted  to  it  by  the  Railroad  Adminis- 
tration. 

In  order  to  familiarize  itself  with  railroad  conditions 
in  so  far  as  they  affected  its  instructions,  the  committee 
has  made  surveys  in  many  parts  of  the  United  States 
and  has  actually  viewed  conditions  in  the  States  of 
Massachusetts,  Connecticut,  New  York,  Pennsylvania, 
Delaware,  Maryland,  Virgmia,  North  and  South 
Carolhia,  Georgia,  Alabama,  Mississippi,  Louisiana, 
Texas,  Arkansas,  Tennessee,  Missouri,  Ohio,  Indiana, 
Illinois,  Minnesota,  North  and  South  Dakota. 

As  the  laws  of  the  Federal  Government  and  of  the 
various  States  directh^  affect  railroad  conditions,  the 
committee  has  confeixed  with  officials  of  the  United 
States  Public  Health  Service  and  with  manj^  State 
health  officers  at  the  State  capitals.  It  also  has  met, 
by  invitation,  with  the  Surgeon  General's  conference 
with  State  and  Territorial  health  officers  in  Washing- 
ton, June  5,  1919,  at  which  time  the  chairman  pre- 
sented a  paper. 

On  February  7,  1919,  a  tentative  program  outlining 
the  work  of  the  committee  was  submitted.  The 
Director  Division  of  Operation  authorized  the  sub- 
mission  of   this   program    to    the   regional   directors. 


The  transcript  of  the  views  of  the  regional  directors 
and  of  some  of  the  Federal  managers  is  transmitted 
herewith. 

The  committee  begs  leave  to  submit  in  addition: 

A  complete  set  of  sanitary  regulations. 

A  set  of  rules  governing  physical  examinations  for 
railroad  employees. 

A  memorandum  in  regard  to  rest  houses. 

A  memorandum  covering  separation  of  claims  and 
surgical  departments. 

A  memorandum  concerning  privilege  of  trip  trans- 
portation to  local  surgeons  to  attend  medical  meetings. 

A  memorandum  concerning  the  control  of  malarial 
fever. 

In  compliance  with  instructions  of  June  17,  1919, 
in  regard  to  first-aid  kits,  the  committee  submits  here- 
with model  outfit  with  directions  for  its  use  and  main- 
tenance, and  an  estimate  of  cost. 

Correspondence  covering  recommendations  of  the 
committee  regarding  the  practice  of  laymen  making 
vision,  hearing,  and  color  examinations  is  submitted. 

The  committee  believes  that  it  would  be  to  the  best 
interests  of  the  Railroad  Administration  if  an  oppor- 
tunity were  granted  for  an  earh^  conference  with  the 
Director  Division  of  Operation,  to  discuss  the  various 
recommendations  herewith  submitted. 
Respectfully, 

D.  Z.  DuNOTT,  M.  D.,  Chairman. 
G.  W.  Cale,  Jr. 
Victor  G.  Heiser. 
H.  M.  Bracken. 
T.  R.  Crowder. 

P.  S. — In  view  of  the  great  importance  of  functional 
reeducation  of  uijured  railway  employees  mentioned 
m  paragraph  1  of  the  committee's  working  program, 
the  committee  tiesires  the  opportunity  of  discussing 
this  subject  with  the  Director  Division  of  Operation 
and  the  regional  directors,  following  which  it  will  make 
its  report  and  recommendations. 


RECOMMENDATIONS   OF   COMMITTEE    ON   HEALTH   AND   MEDICAL  RELIEF. 


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RECOMMENDATIONS   OF   COMMITTEE    ON    HEALTH   AND   MEDICAL,   RELIEF. 


The  committee's  proposal 
to  cooperate  with  the  Public 
Health  Service  in  its  propa- 
ganda against  .venereal  dis- 
ease should  be 'approved. 

£ 

The   committee's   proposal 
concerning    general    sanitary 
improvements  should  be  ap- 
proved.   It  has  been  the  prac- 
tice for  the  lines  in  this  group 
to  endeavor  to  carry  out  the 
necessary  precautions  to  see 
that  our  stations,  shops,  office 
buildings, etc.,  are  maintained 
in  sanitary  condition. 

£ 

The  advisability  of  arrang- 
ing for  trip  transportation  for 
local    surgeons    over    foreign 
linos  as  an  educational  feature 
is  entirely  practicable  and  will 
no  dou]3t  increase  efficiency. 
I  do  not  thiulc  it  possible  to 
eliminate  the  pass  as  a  consid- 
eration of  compensation  and 
make  cash  compensation  fair 
and  reasonable  mthout  greatly 
increasing  the  funds  necessary 
tor  the  operation  of  the  hospi- 
tal department.  Standard  fee 
tables  without  other  means  of 
compensation  are  usually  low 
and  a  source  of  humiliation 
and  discontent  to  the  surgeons 
who   accept  them.    Reason- 
able pass  privileges  for  work  of 
a  limited  character  plus  rea- 
sonable  cash   pajmients   for 
more  e-xtensive  work,  taking 
due  consideration  for  the  pro- 
fessional ability  and  worth  of 
the  doctor  who  renders  the  serv- 
ice, is  much  more  satisfactory 
to  the  raedical  profession  and 
conducive  to  more  interested 
and  efficientservice  to  the  rail- 
way company.    The  experi- 
ence and  professional  ability 
of  the  different  surgeons  along 
the  line  of  a  railroad,  are  by 
no  means  of  equal  value,  and 
can  not  be  justly  regulated  by 
a  standard  fee  table.    Should 
an  equitable  fee  table  be  ar- 
ranged upon  the  basis  of  the 
highest  decree  ofskillattained 
by  a  few  of  the  best  educated 
and  trained  doctors  on  the 
staff,  it  would  be  excessive  and 
prove   almost   prohibitive   if 
applied  to  all. 

p-i 

Relative  to  the  advisability 
of  separating  the  surgical  and 
claim  departments  of  raihoads. 
Sections  A  and  B  do  not  apply 
to  the  Santa  Fe  lines.    Sec- 
tion C  regarding  reports  of  the 
surgeon  to  the  claim  depart- 
ment of  the  railroad  the  pro- 
posal ofthe  committee  should 
not  be  approved.    The  present 
practice  should  in  no  way  vio- 
late the  confidential  relations 
existing  between  the  surgeon 
and    any    honest    and   fair- 
minded  railway  employee.    If 
the  surgeon  i  s  of  the  right  kind, 
he  should  be  so  true  and  im- 
partial in  reporting  his  find- 
ings that  his  confidential  rela- 
tionship with   the  desirable 
employee  should  in  no  way  be 
impaired.    To  endeavor  to  re- 
tain confidential  relationship 
with    a   dishonest   employee 
should  not  be  attempted  by 
declining  to  report  facts  to  the 
claim  department  ofthe  road, 
which  constitutes  the  first  and 
sometimes  the  only  line  of  de- 
fense a  road  has  against  im- 
posters.    The  smallest  part  of 
a  surgeon's  work  pertains  to 
histestimony  in  damagesuits, 
where  of  course  his  opinions 
are  often  discounted  in  some 
measure.    However,  ouronin- 
ionis  that  much  moreis  gained 
by     the    railway     comnany 
being       made       acauainted 
promptly  with  all  the  tacts 
known    both  to  patient  and 
surgeon.  Whereolaimsa:;ainst 
corporations  are  contemplated , 
secrecy  of  any  kind  should  not 
be  tolerated. 

Ph 

Malarial  control  along  rail- 
road lines  could  be  made  very 
valuable  should  the  railroads 
assume  the  expense  of  abolish- 
ing all  stagnant  pools  of  water 
near  the  homes  or  sleeping 
quarters   of  their  employees. 
The  control  of  hookworm  can 
probably  be  better  managed 
by  State  health  boards. 

0 
Ph 

Compulsory    vaccination 
against  smallpox  and  typhoid 
fever  by  cooperation  of  State 
boards    of  health   should    be 
approved  without  reservation. 
This  work  can  be  cared  for  by 
the  hospital  or  jani  nations  now 
existing  when  State  boards  of 
health  have  authority  to  push 
it  and  give  proper  support. 

!^ 

Reconstruction    of  injured 
employees  would  be  an  e.xcel- 
lent  idea  were  the  railroads  to 
remain  imder  Government  con- 
trol.   If  the  roads  are  returned 
to  private  ownership,  it  would 
be  practical  for  the  railroads 
only  in  case  a  group  of  roads 
representing  a  very  large  mile- 
age should  join  their  efforts 
and  provide  ample  funds  for 
reconstruction  work. 

RECOMMENDATIONS    OF   COMMITTEE    ON    HEALTH   AND   MEDICAL,   RELIEF. 


15 


w 

Cooperation   -vnth    Public 
Health    Service    is    highly 
essential  and  railroads  pass- 
ing    through     communities 
where   no   rules  concerning 
health  and  sanitation  are  in 
effect    are    seriously   handi- 
capped. 

1^ 

All  structures  in  which  em- 
ployees are  quartered  could,  it 
is  true,  be  screened  and  imme- 
diate premises  maintained  in 
a  sanitary  condition,  but  it  is 
doubtful   if  employees  using 
these  fa'-ilifies  would  take  suf- 
flcient  interest  in  the  matter 
to  keep  screens  closed   and 
effectually  keep  out  flies  and 
mosquitoes.     Some  improve- 
ment'in  conditions  might  be 
made  by  draining  ponds  in 
neighborhood  of  sleeping  quar- 
ters, those  that  it  would  not 
be  pra-iti  able  to  dram  mieht 
be  treated  with  a  little  fuel 
oil;  water  cars  could  be  occa- 
sionally steamed  out  and  this 
would  probably  go  a  long  way 
toward  reducing  malaria,  al- 
though to  secure  the  maximum 
benefit  from  such   a   course 
would  require  a  uniform  and 
severe  sanitary  program  on 
the  part  of  the  various  State, 
county  and  city  health  officers. 

£ 

Suggestions  applying  to  trip 
transportation    over    foreign 
lines  to  enable  attending  sur- 
gical meetings  outside  of  their 
own  territory  is  considered  a 
good   one.    With   respect   to 
passes,  as  a  basis  of  compensa- 
tion, it  is  our  belief  the  local 
surgeons  at  smaller  stations 
when  given  a  pass  for  their 
services  are  the  best  paid  men 
we  have,  due  to  the  fact  that 
only  a  few  cases  are  treated  by 
them.    It  is  understood,  how- 
ever,   that    soe'^-ial    services, 
that  is,  calls  of  long  distances, 
attending  wrecks,  etc.,  carry 
special  compensation  and  bill 
is  rendered  for  loss  of  time. 
Atlargerstations  and  division 
points,  an  approximate  close 
estimate  of  necessary  work  can 
be  made  and  a  monthly  salary 
appropriately  established. 

PM 

It  is  not  our  practice  to  ap- 
point local  physicians  or  sur- 
geons because  of  their  capacity 
to  handle  employees  from  a 
claim  standpoint,"in  fact  this 
ability  is  not  taken  into  con- 
sideration in  any  instance. 

[1. 

Much  can  be  done  by  the 
railroadsin  the  matter  ofolim- 
inating  malaria,  but  without 
an  intensive  campaign  which 
will  interest  all  communities 
to  a  degree  of  intensive  action 
it  is  thought  that  very  little 
concrete  results  would  obtain, 
especially    in    sections    like 
Louisiana    and    southeastern 
.Texas,'  where  "railroads    run 
through     large     sections     of 
swampy  land,  and  to  drain 
right  of  way  would  prove  ex- 
ceedingly expensive  and  would 
in  return  avail  little  unless 
the  communities  and  adjacent 
land  were  likewise  drained. 

2 

1 

It  is  believed  the  suggestion 
for    compulsory    vaccination 
and  inoculation  for  typhoid 
and  oUier  diseasesis  a  good  one, 
although  it  is  a  proceeding 
which    for   apparent  reasons 
cannot  be  applied  by  the  Rail- 
road Administration  mthout 
the  action  of  State  or  munici- 
pal authorities  which  would 
be  appli-able  to  all  citizens  of 
a  community. 

1 

■Wliile,  of  course,  the  medi- 
cal department  is  \*i  tally  inter- 
ested in  the  reconstruction  of 
sorioush'  injured  employees  to 
enable  tliein  to  eon  tinuein  serv- 
ice,  it    is  also  a  part  of  the 
safet\  work  and  could  not  be 
siuee-isfiilly  handled  through 
our  Ih'sniiiil  organiiation  fur- 
ther ihan  is  now  being  done, 
whiihin  hides  the  appli"ation 
of  anii'u  uil  limbs,  eyes,  etc., 
for  I  he  1  la.Non  that  only  asmall 
pereeiiia^-e  of  employees  are 
permanenily  disabled,  which 
would  hardly  justify  the  out- 
lay in  equipment  and  appli- 
ances   required.    It    is    sug- 
gested that  if  arrangements 
could    be    made,    probably 
through  State  or  muni' ipal 
health  or  other  authorities,  to 
establish  reconstruction  hospi- 
•tals   at   principal  points,   it 
would   more  efficiently,  eeo- 
■nomi  'ally ,  and  generally  satis- 
factorily take  care  of  the  situa- 
tion.   Again,  it  has  been  our 
exjierienee  that  a  large  number 
of  employees  who  are  perma- 
nently disabled  make  settle- 
ments by  court  proceedings  or 
otlier\\'ise  which  are  so  far  from 
satisfactory  that  it  is  prohibi- 
tive to  consider  reemployment, 
even  in  a  less  hazardous  posi- 
tion. 

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EECOMMENDATIONS   OF   COMMITTEE    ON    HEALTH   AND   MEDICAL,   RELIEF. 


f1 

I  think  the  subject  should 
be  taken  up  vigorously  by 
educational  measures.    The 
general  public  is,  of  course,  as 
much  interested  as  the  rail- 
roads and  it  is  to  the  best  in- 
terest of  all  that  full  coopera- 
tion he  given  to  the  Public 
Health  Service.    Some  States 
have  been  for  some  Uttle  time 
conducting  a  vigorous  cam- 
paign along  this  line. 

t^ 

£ 

I  am  heartily  in  favor  of  the 
suggestion  for  general  sanitary 
improvement    in    coimection 
with  railroad  stations,  shops, 
cars,  and  office  buildings  and 
we  have  always  endeavored  to 
improve  the  sanitary  condi- 
tions around  stations,   ofiice 
buildings,  and  in  trains  to  the 
highest  point  and  we  will  con- 
tinue to  do  so. 

£ 

With  reference  to  granting 
trip  passes  to  local  surgeons,  I 
think  if  such  an  arrangement 
can  be  made  it  will  be  of  con- 
siderable benefit  to  the  rail- 
roads in  that  they  will  be  able 
to  secm-e  higher  class  ot  sur- 
geons at  various  points.    This 
privilege  should  be  in  addition 
to  any  compensation  the  sur- 
geon would  receive  as  I  am  not 
in  favor  of  issuance  of  transpor- 
tation as  a  basis  of  compensa- 
tion.   As    indicated    in    the 
memorandum,   this    practice 
would  enable  surgeons  to  at- 
tend the  medical  and  surgical 
meetings,  thereby  increasing 
their     efiiciency.      Anything 
which  increases  the  efhcieucy 
of  a  medical  man  promotes  the 
health  of  the  community  in 
which  he  lives,  increases  the 
earning  power  of  the  nation  as 
a  whole,  and  is  conducive  to 
the    best    interests    of    the 
country.    However,  in  view 
of  the  ruUng  of  the  Interstate 
Commerce  Commission  it  may 
be  desirable  to  have  an  order 
issued  by  the  Director  General 
maklng'a  uniform  regulation 
on  all  hues.    With  reference 
to  compensation,   all  of  our 
division  sm-geons  now  receive 
a  regular  salary.    Some  of  the 
local  surgeons,  however,  are 
placed   on  the   basis   of  free 
transportation   in  return  for 
their  services. 

£ 

Of  the  lines  under  my  juris- 
diction the  Kansas  City  South- 
ern is  the  only  one  ha-s'ing  an 
employees'  hospital  association. 
Our  surgeons  are  appointed  by 
the  chief  surgeon  who  m  turn 
is  chosen  by  the  hospital  asso- 
ciation, whose  board  of  trus- 
tees contains  an  equal  nvunber 
ofofflcialsandemployees.  The 
association  is  in  no  sense  under 
the  jurisdiction  of  the  claim 
department  and  I  do  not  be- 
lieve there  is  any  feeling  among 
the  employees  at  the  present 
time  that  such  is  the  case. 
Where  the  surgical  and  claims 
departments  are  consolidated 
it  might  be  well  to  have  them 
separated.    The    reasons    for 
such  separation,  however,  as 
outlined    in    the    memoran- 
dum 40  not  apply  on  lines 
under  my  jurisdiction. 

£ 

All  departments  of  the  rail- 
road as  well  as  the  general  com- 
munity, I  should  think,  would 
be  greatly  Interested  in  this 
subject.    The  results  shown  in 
Dr.  Dunott's  letter  appear  to 
be  very  encouraging. 

a 
£ 

I  think  all  will  agree  on  the 
effectiveness  and  desirability 
ofsuchvaccination.    Compul- 
sory vaccination  is  now  re- 
quired in  many  public  schools 
and  employees  and  inmates  of 
various  institutions,  and  com- 
pulsory  vaccination    of  rail- 
road    employees    would,    of 
course,  tend  to  bring  about  the 
same  result.    The  attitude  of 
employees  with  respect  to  this 
plan  would,  however,  have  to 
be  considered. 

PM 

The  suggestion  is  a  good  one 
and  such  an  institution  should 
be  geographically  located  to 
serve  the  greatest  number  of 
railroads  in  a  given  territory. 
It  might  also  be  well  to  give 
consideration   to   utilizing    a 
hospital  of  this  kmd  for  taking 
care  of,  m  addition  to  railroad 
employees,    soldiers,    persons 
Injured  inrailroad  and  other 
industrial  accidents.    In  this 
way  I  think  the  work  could  be 
done  more  effectively  and  eco- 
nomically being  on  a  larger 
scale  than  would  be  the  case  if 
it  was  operated  solely  in  be- 
half of  the  railroads  or  some 
other  class  of  industry. 

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3     e  ii 


66 


EECOMMENDATIONS   OF   COMMITTEE    ON   HEALTH   AND   MEDICAL   RELIEF. 


Exhibit  D. 

The  committee  found  a  great  lack  of  uniformity 
within  the  several  States  and  among  the  various  rail- 
roads on  the  subject  of  sanitary  regulations,  and  as  a 
result  of  this  lack  of  uniformity  there  was  created 
much  confusion  and  many  obstacles  to  successful 
operation.  In  many  adjoining  States  conflicting 
regulations  made  it  difficult  to  carry  out  instructions. 
This  matter  was  brought  to  the  attention  of  the  State 
and  Territorial  health  officers,  and  the  committee  was 
asked  to  submit  a  draft  to  them.  The  following  code 
is  an  expression  of  the  work  of  the  committee.  This 
has  been  approved  by  the  Director  General  as  rec  m- 
mendatory  practice  for  the  railroads,  and  has  been 
approved  by  Surg.  Gen.  Blue  of  the  United  States 
Public  Health  Service.     See  letter  next  attached. 

Treasury  Department, 
Bureau   oe   the   Public   Health   Service, 

Washington,  Dccenihei'  5.  1919. 
Dr.  D.  Z.  DuNOTT,  M.  D., 

United  Railroad  Administration,  Washington,  D.  C. 
My  Dear  Doctor  Dunott:     I  have  examined  the  proposed  rail- 
way sanitary  code,  and  I  desii'e  to  congratulate  the  committee  on 
the  excellent  provisions  contained  therein. 

I  have  no  hesitancy  in  giving  my  approval  in  view  of  the  fact 
that  they  conform  to  the  existing  interstate  quarantine  regulations, 
but  this  approval  is  contingent  upon  futme  modification  of  yom- 
code  to  conform  to  contemplated  changes  in  the  interstate  quaran- 
tine regulations. 

Respectfully, 

(Signed)  Rupert  Blue, 

Surgeon  General. 


EAILWAY  SANITARY  CODE. 


REGULATIONS  FOB  THE  MAINTENANCE  OF  SANI- 
TARY CONDITIONS  IN  RAILWAY  CARS,  STATIONS, 
CONSTRUCTION  CAMPS,   SHOPS,  AND  OFFICES. 


I.  Transportation  of  Persons  Having  Communi- 
cable Diseases. 

Section  1.  Persons  not  allowed  to  travel. — No  pei- 
son  knowing  or  suspecting  himself  to  be  afflicted  with 
plague,  cholera,  smallpox,  typus  fever,  or  yellow  fever 
shall  apply  for,  procure,  or  accept  transportation  in 
any  railway  train,  car,  or  other  conveyance  of  a  com- 
mon carrier,  nor  shall  any  person  apply  for,  procure, 
or  accept  such  transportation  for  any  minor,  ward, 
patient,  or  other  person  under  his  charge  if  known 
or  suspected  to  be  so  afflicted. 

Sec  2.  Persons  not  accepted  for  travel. — Common 
carriers  shall  not  accept  for  transportation  in  any  rail- 
way train,  car,  or  other  conveyance  any  person  known 
by  them  to  be  afflicted  with  any  of  the  diseases  enu- 
merated in  section  1. 

Sec.  3.  Restricted  travel. — Common  carriers  shall 
not  accept  for  transportation  on  any  railway  train, 
car,  or  other  conveyance  any  person  known  by  them 


to  be  afflicted  with  diphtheria,  measles,  scarlet  fever, 
epidemic  cerebrospinal  meningitis,  anterior  poliomy- 
elitis, mumps,  whooping  cough,  influenza,  pneumonia, 
epidemic  encephalitis,  septic  sore  throat,  rubella, 
claicken-pox,  or  erysipelas,  or  any  person  known  to  be 
a  carrier  of  thes3  disaases,  unless  such  person  is  placed 
in  a  compartment  separate  from  other  passengers,  is 
accompanied  by  a  properly  qualified  nurse  or  other 
attendant,  and  unless  such  nurs3  or  attendant  shall 
agree  to  comply  and  does  so  comply  with  the  following 
regulations: 

{a)  Communication  with  the  compartment  within 
which  the  patient  is  traveling  shall  be  restricted  to 
the  minimum  consistent  with  the  proper  care  and  safety 
of  the  patient. 

(6)  All  dishes  and  utensils  used  by  the  patient  shall 
be  placed  in  a  5  per  cent  solution  of  carbolic  acid  or 
other  fluid  of  equivalent  disinfecting  value  for  at  least 
one  horn-  after  they  have  been  used  and  before  being 
allowed  to  leave  the  compartment. 

(c)  All  sputum  and  nasal  discharges  from  the  patient 
shall  be  received  in  gauze  or  paper,  which  shall  be  de- 
posited in  a  paper  bag  or  in  a  closed  vessel,  and  shall  be  • 
destroyed  by  burning. 

{d)  Said  nurse  or  attendant  shall,  after  performing 
any  service  to  the  patient,  at  once  cleanse  the  hands 
by  washing  them  in  a  2  per  cent  solution  of  carbolic 
acid  or  other  fluid  of  equivalent  disinfecting  value. 

Sec.  4.  Typhoid  and  dysentery. — Conmion  carriers 
shall  not  accept  for  transportation  on  any  railway 
train,  car,  or  other  conveyance  any  person  known  by 
them  to  be  afflicted  with  typhoid  fever,  paratyphoid 
fever,  or  dysentery,  unless  said  person  is  placed  in  a 
cornpartment  separate  from  other  passengers,  is  ac- 
companied by  a  properly  qualified  nurse  or  other 
attendant,  and  unless  said  nurse  or  attendant  shall 
agree  to  comply  and  does  so  comply  with  the  following 
regulations : 

{a)  Communication  with  the  compartment  in  which 
the  patient  is  traveling  shall  be  limited  to  the  mini- 
mum consistent  with  the  proper  care  and  safety  of  the 
patient. 

(b)  All  dishes  and  utensils  used  by  the  patient  shall 
be  placed  in  a  5  per  cent  solution  of  carbolic  acid  or 
other  fluid  of  equivalent  disinfecting  value  for  at  least 
one  horn*  after  they  have  been  used  and  before  being 
allowed  to  leave  the  compartment. 

(c)  All  urine  and  feces  of  the  patient  shall  be  re- 
ceived into  a  5  per  cent  solution  of  carbolic  acid  or 
other  fluid  of  equivalent  disinfecting  value,  placed  in 
a  covered  vessel  and  allowed  to  stand  for  at  least  two 
hours  after  the  last  addition  thereto  before  being 
emptied. 

isl)  A  sheet  of  rubber  or  other  impervious  material 
shall  be  carried  and  shall  be  spread  between  the  sheet 
and  the  mattress  of  any  bed  that  may  be  used  by  the 
patient  while  in  transit. 


EE(!OMMKNDATIONS   ()]'■■    COMMITTEE    ON    HEALTH   AND   MEIJICAL   RELIEl'. 


6T 


(e)  Said  niirso  or  attendant  shall  use.  all  necessary 
precautions  to  prevent  the  access  of  flies  to  the  patient 
or  his  discharges,  and  after  performing  any  service  to 
tlie  patient  shall  at  once  cleanse  the  hands  by  washing 
them  in  a  2  per  cent  solution  of  carbolic  acid  or  other 
fluid  of  equivalent  disinfecting  value. 

if)  Provided,  That  if  a  person  with  typhoid  or 
(.lysentery  is  presented  at  a  railway  station  in  ignorance 
of  these  regidations,  and  his  transportation  is  necessary 
as  a  life  saving  or  safe-guarding  measure,  an  emergency 
may  be  declared  and  the  patient  may  be  carried  a 
reasonable  distance  in  a  baggage  car  if  accompanied 
by  an  attendant  responsible  for  his  care  and  removal: 
Provided  also,  That  regulations  (a),  (6),  (c),  (d),  and  (e) 
of  this  section  shall  be  complied  with  in  so  far  as  the 
circumstances  will  allow,  and  that  all  bedding,  cloth- 
ing, rags  or  cloths,  used  by  the  patient  shall  be  removed 
with  him:  And  provided  jurtTier,  That  any  parts  of  the 
car  which  have  become  contaminated  by  any  dis- 
charges of  the  patient  shall  be  disinfected  at  the  end 
of  the  run  by  washmg  with  a  5  per  cent  solution  of 
carbolic  acid  or  other  fluid  of  equivalent  disinfecting 
value. 

Sec.  5.  Restricted  application  for  transportation. — 
No  person  knowing  or  suspecting  himself  to  be  afflicted 
with  any  of  the  diseases  mentioned  in  sections  3  and  4 
shall  apply  for,  procure,  or  accept  transportation  in 
any  railway  train,  car,  or  other  conveyance  of  a  com- 
mon carrier,  nor  shall  any  person  apply  for,  procure,  or 
accept  such  transportation  for  any  minor,  ward, 
patient,  or  other  person  under  liis  charge,  if  known  or 
suspected  to  be  so  afflicted,  unless  he  shall  have  agreed 
to  and  made  all  necessary  arrangements  for  complying 
and  does  so  comply  with  the  regulations  set  forth  in 
said  sections  3  and  4. 

Sec.  6.  Suspected  cases. — If  a  conductor  or  other 
person  in  charge  of  a  railway  train,  car,  or  other 
conveyance  of  a  common  carrier,  or  an  agent  or  other 
person  in  charge  of  a  railway  station,  shall  have  any 
reason  to  suspect  that  a  passenger  or  a  person  con- 
templating passage  is  afflicted  with  any  of  the  diseases 
enumerated  in  sections  1,  3,  and  4,  he  shall  notify  the 
nearest  health  officer,  or  company  physician  if  the 
health  officer  is  not  available,  by  the  quickest  and  most 
practicable  means  possible,  of  his  suspicion:  and  said 
health  officer  or  physician  shall  immediately  proceed 
to  the  train,  car,  or  other  conveyance  at  the  nearest 
possible  point,  or  to  the  railway  station,  to  determine 
whether  such  disease  exists. 

Sec.  7.  Disposition. — If  the  health  officer  or  phy- 
sician, as  provided  for  in  section  6,  shall  find  any  such 
person  to  be  afflicted  with  any  of  the  diseases  enum- 
erated in  sections  1,  3,  and  4,  he  shall  remove  such 
pc^rson  from  the  station  or  conveyance,  or  shall  isolate 
him  and  arrange  for  his  removal  at  the  nearest  con- 
venif-nt  point;  shall  treat  the  car  or  other  conveyance 
as  infected  premises,  allowing  it  to  proceed  to  a  con- 


venient place  for  proper  treatment  if  in  his  judgment 
consistent  with  the  public  welfare,  in  such  case  notify- 
ing the  health  officer  in  whose  jurisdiction  the  place  is 
located;  and  shall  take  such  other  measures  as  will 
protect  the  public  health:  Provided,  That  if  not  pro- 
hibited in  sections  1  and  2  of  these  regulations  the 
afflicted  person  so  found  may  be  allowed  to  continue 
his  travel  if  arrangements  are  made  to  comply,  and  he 
does-  so  comply,  with  the  requirements  of  the  section 
of  these  regulations  pertaining  to  the  disease  with 
which  he  is  afflicted. 

Sec.  8.  leprosy. — Common  carriers  shall  not  accept 
for  transportation  nor  transport  in  any  railway  train, 
car,  or  other  conveyance  any  person  known  bj^  them  to 
be  afflicted  withleprosy,  unless  such  person  presents  per- 
mits from  the  Surgeon  General  of  the  United  States  Pub- 
lic Health  Service  or  his  accredited  representative,  and 
from  the  State  department  of  health  of  the  States  from 
which  and  to  which  he  is  traveling,  stating  tha  t  such 
person  may  be  received  under  such  restrictions  as  wiU 
prevent  the  spread  of  the  disease,  and  said  restrictions 
shall  be  specified  in  each  instance ;  and  no  person  know- 
ing or  suspecting  liimself  to  be  afflicted  with  leprosy, 
nor  any  person  acting  for  him,  shall  apply  for,  procure, 
or  accept  transportation  from  any  common  carrier 
unless  such  permits  have  been  received  and  are  pre- 
sented, and  unless  the  person  so  afflicted  agrees  to 
comply  and  does  so  comply  with  the  restrictions  or- 
dered. If  any  agent  of  a  common  carrier  shall  suspect 
that  any  person  in  a  train,  car,  or  other  conveyance,  or 
at  a  railway  station,  is  afflicted  with  leprosy,  he  shall 
proceed  as  directed  in  the  case  of  other  suspected  dis- 
eases in  sections  6  and  7  of  these  regulations. 

Sec.  9.  Pulmonary  tuberculosis. — Common  carriers 
shall  not  accept  for  transportation  any  person  known 
by  them  to  be  afflicted  with  pulmonary  tuberculosis  in 
a  communicable  stage  unless  said  person  is  provided 
with  (a)  a  sputum  cup  made  of  impervious  material 
and  so  constructed  as  to  admit  of  being  tightly  closed 
when  not  in  use,  (b)  a  sufficient  supply  of  gauze,  papers, 
or  similar  articles  of  the  proper  size  to  cover  the  mouth 
and  nose  while  coughing  or  sneezing,  (c)  a  heavy  paper 
bag  or  other  tight  container  for  receiving  the  soiled 
gauze,  paper,  or  similar  articles;  and  unless  such  person 
shall  obhgate  himself  to  use  the  articles  provided  for  in 
the  maimer  intended,  and  to  destroy  said  articles  by 
burning  or  to  disinfect  them  by  immersing  for  at  least 
one  hour  in  a  5  per  cent  solution  of  carbolic  acid  or 
other  solution  of  equivalent  disinfecting  value;  nor 
shall  any  person  knowing  himself  to  be  so  afflicted  ap- 
ply for,  procure,  or  accept  transportation  unless  he 
shall  have  agreed  to  and  made  all  necessary  arrange- 
ments for  complying  and  does  so  comply  with  the  regu- 
lations as  set  forth  in  this  section. 

Sec.  10.  Conveyances  vacated  by  infected  persons. — 
Immediately  after  vacation  by  a  person  having  any  of 
the  diseases  mentioned  in  sections  1,  3,  4,  and  S,  or  at 


68 


RECOMMENDATIONS   OF    COMMITTEE    ON    HEALTH   AND   MEDICAL   RELIEF. 


the  end  of  the  trip  on  which  such  person  was  carried,  the 
car  or  other  conveyance  shall  be  thoroughly  cleaned, 
and  the  blankets  and  linen  used  by  such  person  shall 
be  laundered. 

II.  Water  and  Ice  Supplies. 

Sec  11.  "Water  to  be  certified. — Water  provided  by 
common  carriers  for  drinking  or  culinary  purposes  in 
railway  trains,  caz's,  or  other  conveyances,  or  in  railway 
stations,  shall  not  be  taken  from  a  supply  which  is  not 
certified  as  meeting  the  required  standards  of  purity 
and  safety  from  contamination  prescribed  by  the  Inter- 
state Quarantine  Regulations  of  the  United  States. 
Common  carriers  are  required  to  forward  semiannually 
a  list  of  water  supplies  so  used  to  the  Surgeon  General 
of  the  United  States  Public  Health  Service,  Washing- 
ton, D.  C,  and  to  the  respective  State  departments  of 
health  having  direct  jurisdiction,  requesting  the  issu- 
ance of  certificates  of  examination  permitting  the  use 
of  the  supplies  enumerated.  Such  certificates  when 
issued  shall  be  kept  in  the  files  of  the  common  carrier 
during  the  current  period  in  force.  The  issuance  of  a 
certificate  imfavorable  to  the  use  of  a  supply  forbids  its 
further  use  for  drinking  and  culinary  purposes  until 
favorably  certified.  A  favorable  certificate  must  also 
be  secured  permitting  the  use  of  any  supplies  substi- 
tuted for  such  condemned  supplies. 

Melted  natural  ice  used  as  water  supply  for  drinking 
and  culinary  purposes  must  be  from  sources  of  known 
safety  and  covered  by  certificates  of  examination  sim- 
ilar to  those  required  for  water  supply  for  drinking  and 
culinary  purposes  used  in  interstate  traffic,  and  such 
ice  must  be  so  melted  as  to  prevent  subsequent  con- 
tamination. 

Sec.  12.  Ice. — Ice  used  for  cooling  water  provided 
as  in  section  1 1  shall  be  clear  natural  ice,  ice  made  from 
distilled  water,  or  ice  made  from  water  certified  as 
aforesaid;  and  before  the  ice  is  put  into  tlie  water  it 
ghall  be  washed  with  water  of  known  safety,  and  han- 
dled in  such  manner  as  to  prevent  its  becoming  contam- 
inated by  the  organisms  of  infectuous  diseases:  Pro- 
vided, That  the  foregoing  shall  not  apply  to  ice  tliat 
does  not  come  in  contact  with  the  water  to  be  cooled. 

Sec.  13.  Water  containers. — Water  containers  in 
newly  constructed  cars  and  those  newly  installed  in 
stations  shall  be  so  constructed  that  ice  for  cooling  does 
not  come  in  contact  with  the  water  to  be  cooled :  Pro- 
vided, That  after  July  1,  1922,  all  water  containers  in 
cars  and  stations  shall  be  so  constructed  that  ice  does 
not  come  in  contact  with  the  water. 

Sec  14.  Care  of  water  containers. — AU  water  con- 
tainers where  water  and  ice  are  put  into  the  same  com- 
partment, shall  be  thoroughly  cleansed  at  least  once  in 
each  week  that  they  are  in  use.  All  water  containers 
and  water  storage  tanks  shall  be  thoroughly  drained 
and  flushed  at  intervals  of  not  more  than  one  month. 
All  water  containers  shall,  whenever  practicable,  be 


disinfected  at  intervals  of  not  more  than  one  month; 
and  similar  disinfection  shall,  whenever  practicable, 
be  made  of  water  storage  tanks. 

Sec  15.  Filling  water  containers. — Portable  hose  or 
tubing  that  is  used  for  filling  drinking-water  contain- 
ers, or  car  storage  tanks  from  which  such  containers 
are  filled,  shall  have  smooth  metal  nozzles  which  shall 
be  protected  from  dirt  and  contamination;-  and  before 
the  free  end  or  nozzle  of  said  hose  or  tubing  is  put  into 
the  water  container  or  car  storage  tank  it  shall  be 
flushed  and  washed  by  a  plentiful  stream  of  water. 

III.  Cleaning  and  Disinfection  of  Cars. 

Sec  16.  General. — All  railway  passenger  cars  or 
other  public  conveyances  shall  be  kept  in  a  reasonably 
clean  and  sanitary  condition  at  all  times  when  they 
are  in  service,  to  be  insured  by  mechanical  cleaning  at 
terminals  and  lay-over  points. 

Sec  17.  Cleaning. — All  day  coaches,  parlor  cars, 
buffet  cars,  dining  cars,  and  sleeping  cars  shall  be 
brushed,  swept,  and  dusted  at  the  end  of  each  round 
trip,  or  at  least  once  in  each  day  they  are  in  service, 
and  shall  be  thorouglfiy  cleaned  at  intervals  of  not 
more  than  seven  days. 

Sec  18.  Thorough  cleaning. — Thorough  cleaning 
shall  consist  of  scrubbing  the  exposed  floors  with  soap 
and  water;  similarly  scrubbing  the  toilets  and  toilet- 
room  floors;  wiping  down  the  wookwork  with  moist  or 
oiled  cloths;  thorough  dusting  of  upholstery  and  car- 
pets by  beating  and  brushing,  or  by  means  of  the 
vacuum  process  or  compressed  air;  washing  or  other- 
wise cleaning  windows ;  and  the  thorough  airing  of  the 
car  and  its  contents. 

Sec.  19.  Odors  in  cars. — When  offensive  odors  ap- 
pear in  toilets  or  other  parts  of  the  car  which  are  not 
obliterated  and  removed  by  cleaning  as  in  section  18, 
said  toilets  or  other  parts  of  the  car  shall  be  treated 
with  a  1  per  cent  solution  of  forriialdehyde  or  other 
odor-destroying  substance. 

Sec  20.  Vermin  in  cars. — Whenever  a  car  is  known 
to  have  become  infested  with  bedbugs,  lice,  fleas,  or 
mosquitoes,  such  car  shall  be  so  treated  as  to  effectively 
destroy  such  insects,  and  it  shall  not  be  used  in  service 
until  such  treatment  has  been  given. 

IV.  Cars  in  Service. 

Sec  21.  Cleaning. — The  cleaning  of  cars  while 
occupied  shall  bo  limited  to  the  minimum  consistent 
with  the  maintenance  of  cleanly  conditions,  and  shall 
be  carried  out  so  as  to  cause  the  least  possible  raising 
of  dust  or  other  annoyance  to  passengers. 

Sec  22.  Sweeping. — Dry  sweeping  of  the  interior 
of  a  car  in  transit  with  an  ordinary  broom  is  prohib-' 
ited. 

Sec  23.  Dusting. — Dry  dusting  of  the  interior  of 
a  car  in  transit  is  proliibited. 


BEGOMMENOATIONS   OF    COiMMlTTKK    ON    HEALTH   AND   MEDIC!AL   RELIEF. 


69 


Sec.  24.  Brushing. — The  )_)rii,shiiig  of  passengers' 
clothing  in  the  ])ofly  of  the  car  in  transit  is  prohibited. 

Sec.  25.  Drinking  cup. — Individual  drinking  cups  in 
suflicient  number  shall  be  supplied  in  aU  cars,  and  the 
use  of  common  drinking  cups  is  prohibited. 

Sec.  26.  Towels. — The  supplying  of  roller  towels'  or 
other  towels  for  common  use  in  cars  is  prohibited. 

Sec.  27.  Comb  and  brush. — The  supplying  of  combs 
and  brushes  for  common  use  in  cars  is  prohibited. 

Sec.  28.'  Spitting. — Spitting  on  the  floors,  carpets, 
walls,  or  other  parts  of  cars  by  passengers  or  other 
occupants  of  them  is  prohibited. 

Sec.  29.  Cuspidors. — An  adequate  supply  of  cuspi- 
dors shall  be  provided  in  all  sleeping  cars,  smoking 
cars,  and  smoking  compartments  of  cars  while  in  serv- 
ice. Said  cuspidors  shall  be  cleaned  at  the  end  of  each 
trip,  and  oftener  if  their  condition  requires. 

Sec.  30.  Brushing  of  teeth. — Spitting  into  or  brush- 
ing the  teeth  over  washbasins  in  cars  is  prohibited. 
Separate  basins  for  brushing  the  teeth  shall  be  pro- 
vided in  the  wash  rooms  of  sleeping  cars. 

Sec.  31.  Drinking  water  and  ice. — Drinking  water 
and  ice  on  railway  cars  shall  be  supplied  in  accordance 
with  the  conditions  set  forth  in  sections  11,  12,  13,  14, 
and  15  of  these  regulations. 

Sec.  32.  Ventilation  and  heating. — All  cars  when 
in  service  shall  be  provided  with  an  adequate  supply 
of  fresh  air,  and  in  cold  weather  shall  be  heated  so  as 
to  maintain  comfort.  When  artificial  heat  is  neces- 
sary the  temperature  should  not  exceed  70°  F.,  and 
in  sleeping  cars  at  night  after  passengers  have  retired 
it  should  not  exceed  60°  F. 

Sec.  33.  Toilets  in  dining  cars, — A  proper  toilet 
room  and  lavatory  shall  be  provided  in  all  dining  cars 
for  the  use  of  dining-car  employees,  and  the  same  shall 
be  supplied  with  toilet  paper,  soap,  and  clean  towels, 
and  shall  be  kept  in  a  clean  and  sanitary  condition. 
Such  toilet  room  shall  have  no  direct  connection  with 
the  kitchen,  pantry,  or  other  place  where  food  is 
prepared. 

Sec.  34.  Toilets  in  other  cars. — A  proper  toilet  room 
and  lavatory  shall  be  provided  in  all  railway  passenger 
cars,  express  cars,  mail  cars,  and  baggage  cars  for  the 
use  of  their  occupants.  Such  toilets  shall  be  supplied 
with  toilet  paper,  soap,  and  free  or  pay  clean  towels, 
and  shall  be  kept  in  a  clean  and  sanitary  condition. 

Sec.  35.  Toilets  to  be  locked. — The  toilet  rooms  in 
all  railway  cars  shall  be  locked  or  otherwise  protected 
from  use  while  trains  are  standing  at  stations, passing 
through  cities,  or  passing  over  watersheds  draining  into 
reservoirs  furnishing  domestic  water  supplies,  unless 
adequate  water-tight  containers  are  securely  placed 
under  the  discharge  pipe. 

Sec.  36.  Dining  cars  to  be  screened. — Dining  cars 
shall  be  screened  against  the  entrance  of  flies  and 
other  insects,  and  it  .shall  be  the  duty  of  dining-car 


employees  to  destroy  flies  or  other  insects  that  may 
gain  entrance. 

Sec.  37.  Dining  car  employees  to  cleanse  hands.  — 
Dining  car  employees  shall  thorough!}^  cleanse  their 
hands  by  washing  with  soap  and  water  after  using 
a  toilet  or  urinal,  and  immediately  before  beginning 
service. 

Sec.  38.  Care  of  tableware. — All  cooking,  table,  and 
kitchen  utensils,  drinking  glas.^es,  and  crockery  used 
in  the  preparation  or  serving  of  food  or  drink  in  dining 
cars  shall  be  thoroughly  washed  in  boUing  water  and 
suitable  cleansing  material  after  each  time  they  are 
used . 

Sec.  39.  Food  containers. — Refrigerators,  food 
boxes,  or  other  receptacles  for  the  storing  of  fresh  food 
in  dining  and  buffet  cars  shall  be  emptied  and  thor- 
oughly washed  with  soap  and  hot  water  and  treated 
with  a  1  to  3,000  solution  of  permanganate  of  potash 
or  other  approved  deodorant  at  least  once  in  each 
seven  days  that  they  are  in  use. 

Sec.  40.  Food  and  milk. — No  spoiled  or  tainted 
food,  whether  cooked  or  uncooked,  shall  be  served  in 
any  dining  car;  and  no  milk  or  milk  products  shall  be 
served  unless  the  milk  has  been  pasteurized  or  boiled. 

Sec.  41.  Garbage. — Garbage  cans  in  sufficient  num- 
ber, and  with  suitable  tight-fitting  covers,  shall  be 
provided  in  dining  cars  to  care  for  aU  refuse  food  and 
other  wastes,  and  such  wastes  shall  not  be  thrown 
from  the  car  along  the  right-of-way. 

Sec.  42.  Dining  car  inspection. — The  chief  of  the 
dining  car  shall  be  responsible  for  comphauce  with  all 
dining  car  regulations,  and  he  shall  make  an  inspection 
of  the  car  each  day  for  the  purpose  of  maintaining  a 
rigorous  cleanliness  in  all  portions  thereof. 

Sec.  43.  Examination  of  food  handlers. — No  person 
shall  be  employed  as  a  cook,  waiter,  or  in  any  other 
capacity  in  the  preparation  or  serving  of  food  in  a 
dining  car  who  is  known  or  suspected  to  have  any 
dangerous  communicable  disease;  and  all  persons  so 
employed  shall  undergo  a  physical  examination  by  a 
competent  physician  before  being  assigned  to  service, 
and  before  returning  to  work  after  any  disabling  ill- 
ness, to  determine  their  freedom  from  such  diseases, 
and  shall  be  immediately  relieved  from  service  if 
found  to  be  so  afflicted.  There  shall  be  a  monthly 
medical  inspection  for  dangerous  communicable  dis- 
eases. To  determine  persons  afflictedw  ith,  or  carriers 
of,  typhoid  fever,  tuberculosis,  dysentery,  diphtheria, 
streptococcic  sore  throat,  scarlet  fever,  gonorrhea, 
syphdis,  etc.,  a  laboratory  examination  shall  be  made 
if  necessary. 

V.  Eailway  Stations. 

Sec.  44.  General. — All  railway  stations,  including 
their  waiting  rooms,  lunch  rooms,  restaurants,  wash 
rooms,  and  toilets,  shall  be  kept  in  a  clean  and  sani- 


70 


RECOMMENDATIONS   OF    COMMITTEE    ON    HEALTH    AND    MEDICAL  RELIEF. 


tary  coudition  at  all  times,  to  be  insured  by  mechanical 
cleaning  at  regular  intervals. 

Sec.  45.  Cleaning.^ — All  waiting  rooms  and  other 
rooms  used  by  the  public  shall  be  swept  and  dusted 
daily;  and  at  intervals  of  not  more  than  seven  days 
the  floors  shall  be  scrubbed  with  soap  and  water,  and 
the  seats,  benches,  counters,  and  other  woodwork 
shall  be  similarly  scrubbed,  or  shall  be  rubbed  down 
with  a  cloth  moistened  with  oil. 

Sec.  46.  Sweeping. — If  sweeping  is  done  while 
rooms  are  occupied  or  open  to  occupancy  by  patrons, 
the  floor  shall  be  first  sprinlded  with  wet  sawdust  or 
other  dust-absorbing  material. 

Sec  47.  Dusting. — If  dusting  is  done  while  rooms 
are  occupied  or  open  to  occupancy  by  patrons,  it  shall 
be  done  only  with  cloths  moistened  with  water,  oil  or 
other  dust-absorbing  material. 

Sec.  48.  Spitting. — Spitting  on  the  floors,  walls, 
seats,  or  platforms  of  railway  stations  is  prohibited. 

Sec  49.  Cuspidors. — In  all  waiting  rooms  where 
smoking  is  permitted  an  adequate  supply  of  cuspidors 
shall  be  provided;  such  cuspidors  shall  be  cleaned 
daily,  and  oftener  if  their  condition  requires. 

Sec.  50.  Common  cups. — Individual  drinking  cups 
in  sufficient  number  shall  be  supplied  in  all  stations, 
and  the  use  of  common  drinking  cups  is  prohibited. 

Sec  51.  Common  towels. — The  supplying  of  roller 
towels  or  other  towels  for  common  use  in  railway  sta- 
tions is  prohibited. 

Sec  52.  Combs  and  brushes. — The  supplying  of 
combs  and  brushes  for  common  use  in  railway  stations 
is  prohibited. 

Sec  53.  Toilet  facilities. — All  railway  stations 
where  tickets  are  sold  shall  provide  adequate  toUet 
facilities,  of  a  design  approved  by  the  State  department 
of  health,  for  the  use  of  patrons  and  employees;  and 
there  shall  be  seperate  toilets  for  each  of  the  two  sexes. 

Sec  54.  Station  toilets. — If  a  railway  station  is  lo- 
cated within  300  feet  of  a  public  sewer,  water-flushing 
toilets  shall  be  installed  and  permanently  connected 
with  such  sewer,  and  a  wash  basin  or  basins  shall  be 
located  near  the  toilet  and  similarly  connected;  and 
svich  toilets  and  lavatories  shall  be  kept  in  repair  and 
in  good  working  order  at  all  times. 

Sec  55.  Care  of  toilets. — All  toilets  installed  as  set 
forth  in  section  54  shaU  be  cleaned  daily  by  scrubbing 
the  floors,  bowls,  and  seats  with  soap  and  water. 

Sec.  56.  Odors  in  toilets. — When  offensive  odors 
appear  in  toilets  which  are  not  obliterated  and  re- 
moved by  cleaning  as  in  section  55,  said  toilets  shall 
be  treated  with  a  1  per  cent  solution  of  formaldehyde 
or  other  odor-destroying  substance. 

Sec  57.  Toilet  supplies. — Toilets  and  wash  rooms 
installed  as  set  forth  in  section  54  shall  be  constantly 
furnished  with  an  adequate  supply  of  toilet  paper, 
soap,  and  free  or  pay  clean  towels. 

Sec  58.  Privies. — If  no  sewer  connection  is  avail- 
able as  set  forth  in  section  54,  a  sanitary  privy  of  a 


design  approved  by  the  State  department  of  health 
shall  be  maintained  within  a  reasonable  distance  from 
the  station.  Such  privy  shall  be  adequately  protected 
against  the  entrance  of  flies,  shall  be  kept  supplied 
with  toUet  paper,  the  seats  shall  be  kept  clean,  and  the 
vaults  shall  be  treated  with  sodium  hydrate  or  other 
approved  disinfectant  at  least  once  in  each  week  and 
shall  be  cleaned  out  and  emptied  at  such  intervals  as 
will  avoid  the  development  of  a  nuisance. 

Sec  59.  Drinking  water  and  ice. — Drinking  water 
and  ice  in  railway  stations  shall  be  supplied  in  accord- 
ance with  sections  11,  12,  13,  14,  and  15  of  these  regu- 
lations. 

Sec  60.  Water  not  usable  for  drinking. — If  water 
which  does  not  conform  to  the  standards  set  forth  in 
section  1 1  of  these  regulations  is  available  at  any  tap 
or  hydrant  or  in  a  railway  station,  a  notice  shall  be 
maintained  on  each  such  tap  or  hydrant  which  shall 
state  in  prominent  letters,  "Not  fit  for  drinking. " 

Sec  61.  Drinking  fountains. — If  drinking  fountains 
of  the  bubbling  type  are  provided  in  any  railway  sta- 
tion, they  shall  be  so  made  that  the  drinking  is  from  a 
free  jet  projected  at  an  angle  to  the  vertical  and  not 
from  a  jet  that  is  projected  vertically  or  that  flows 
through  a  filled  cup  or  bowl. 

Sec.  62.  Refuse  cans. — At  aU  railway  stations  where 
there  is  an  agent  there  shaU  be  provided  and  maintain- 
ed an  adequate  supply  of  open  or  automatically  closing 
receptacles  for  the  deposition  of  refuse  and  rubbish, 
and  such  receptacles  shall  be  emptied  daily  and  kept 
reasonably  clean  and  free  from  odor. 

Sec  63.  Cisterns,  cesspools,  etc. — All  cisterns,  water- 
storage  tanks,  and  cesspools  in  or  about  railway  sta- 
tions shall  be  adequately  screened  against  the  entrance 
of  mosquitoes,  and  all  collections  of  surface  water  on 
station  property  shall  be  drained  or  oiled  during  the 
season  of  mosquito  fliglit,  to  prevent  the  breeding  of 
mosquitoes. 

Sec  64.  Restaurants  to  be  screened. — All  restau- 
rants and  lunch  rooms,  or  other  places  where  food  is 
prepared  or  served  in  a  railway  station,  shall  have 
doors  and  windows  adequately  screened  against  the 
entrance  of  flies  during  the  season  of  flight  of  these 
insects;  and  aU  food  on  display  or  storage  racks  shall 
be  adequately  covered. 

Sec  65.  Lavatories  for  restaurants. — A  lavatory  of 
easy  and  convenient  access  shall  be  provided  for  the 
use  of  employees  in  every  restaurant  or  lunch  room  in 
any  railway  station,  and  it  shall  be  provided  with  an 
adequate  supply  of  water,  soap,  and  clean  towels. 

Sec  66.  Restaurant  employees. — Restaurant  em- 
ployees who  are  engaged  in  the  preparing  or  serving  of 
food  shall  thorouglily  cleanse  their  hands  by  washing 
with  soap  and  water  after  using  a  toilet  or  urinal,  and 
immediately  before  beginning  service. 

Sec  67.  Kitchen  and  table  utensils. — AH  cooking, 
table,  and  kitchen  utensils,  drinking  glasses,  and  crock- 
ery used  in  the  preparation  or  serving  of  food  or  drink 


RECOMMENDATIONS   OF   COMMITTEE    ON    HEALTH    AND   MEDICAL   RELIEF. 


71 


in  railway  rPfStaurants  or  luncii  rooms  shall  be  thor- 
oughly washed  in  hoiling  water  and  suitable  cleansing 
material  after  each  time  they  are  used. 

Sec.  68.  Food  containers. — Refrigerators, food  boxes, 
or  other  receptacles  for  the  storing  of  fresh  food  in 
railway  restaurants  or  lunch  rooms  shall  be  emptied 
and  thoroughly  washed  with  soap  and  hot  water  and 
treated  with  a  1  to  3,000  solution  of  perm.anganate  of 
potash  or  other  approved  deodorant  at  least  once  in 
each  seven  days  that  they  are  in  use. 

Sec  69.  Garbage. — Garbage  cans  in  sufficient  num- 
ber, and  with  suitable  tight-fitting  covers,  shall  be  pro- 
vided in  all  restaurants  and  lunch  room.g  to  care  for  aU 
refuse  food  and  other  wastes;  and  such  cans  shall  be 
emptied  daily  in  an  approved  place  and  kept  in  a  clean 
and  sanitary  condition. 

Sec  70.  Restaurant  inspection. — The  manager,  chief , 
or  other  person  in  charge  of  any  railway  restaurant 
or  lunch  room  shall  .be  responsible  for  compliance 
with  all  regulations  pertaining  thereto,  and  he  shall 
make  an  inspection  of  the  premises  daily  for  the  pur- 
pose of  maintaining  a  rigorous  cleanliness  in  all  parts 
thereof. 

Sec.  71.  Station  inspection. — The  agent,  manager, 
or  other  person  in  charge  of  any  railway  station  shall 
be  responsible  for  compliance  with  all  regulations  per- 
taining thereto,  and  he  shall  make,  or  have  made  by  a 
responsible  person  reporting  to  him,  frequent  inspec- 
tions of  the  premises  for  the  purpose  of  maintaining  a 
rigorous  compliance  with  aU  such  regulations. 

Sec  72.  Examination  of  food  handlers. — No  person 
shall  be  employed  as  a  cook,  waiter,  or  in  any  other  ca- 
pacity in  the  preparation  or  serving  of  food  in  a  rail- 
way restaurant  or  lunch  room  who  is  known  or  sus- 
pected to  have  any  dangerous  communicable  disease; 
and  all  persons  so  employed  shall  undergo  a  physical 
examination  by  a  competent  physician  before  being 
assigned  to  service,  and  before  returning  to  work  after 
any  disabhng  iUness,  to  determine  their  freedom  from 
such  diseases,  and  shall  be  immediately  relieved  from 
service  if  found  to  be  so  afHicted.  There  shall  be  a 
monthly  medical  inspection  for  dangerous  communi- 
cable diseases.  To  determine  persons  afflicted  with, 
or  carriers  of,  typhoid  fever,  tuberculosis,  dysentery, 
diphtheria,  streptococic  sore  throat,  scarlet  fever, 
gonorrhea,  sj^ihUis,  etc.,  a  laboratory  examination 
shall  be  made  if  necessary. 

VI.  Construction  Camps. 

Sec.  73.  Definition. — For  the  purposes  of  these 
regulations  railway  construction  camps  shall  be  con- 
sidered to  include  aU  camps  and  similar  places  of  tem- 
porary abode,  including  those  on  wheels,  established  by 
or  for  the  care  of  working  forces  engaged  in  the  con- 
struction, repair,  or  alteration  of  railway  properties  or 
parts  thereof:  Provided,  That  camps  which  are  occu- 
pied by  less  than  five  people,  or  camps  which  are  estab- 


lished to  meet  emergency  conditions  and  are  not  occu- 
pied longer  than  five  days  .shall  not  be  included,  except 
that  section  90  of  these;  regulations  shall  apply  to  them. 

Sec.  74.  General. — All  camps  shall  be  so  located  and 
sc  maintained  as  to  be  conducive  to  the  health  of  their 
occupants  and  not  to  endanger  the  health  of  the  pub- 
lic; and  all  tents,  houses,  stables,  or  other  structures 
therein  shall  be  kept  in  a  reasonabl}^  clean  and  sanitary 
condition  at  all  times. 

Sec.  7.5.  location. — Camps,  except  those  on  wheels, 
should  be  located  on  high,  well-draiiied  ground:  any 
natural  sink-holes,  pools,  or  other  surface  coUectioas 
of  water  in  the  immediate  vicinity  should  be  drained 
and  filled  when  the  camp  is  first  established:  and  all 
such  water  not  subject  to  complete  drainage  should 
have  the  surface  oiled  at  intervals  of  not  more  than 
seven  days  during  the  season  of  mosquito  flight. 

Sec  76.  Arrangement. — The  general  scheme  of  re- 
lations of  the  structures  of  a  camp  should  be  as  follows: 
The  kitchen  should  be  located  at  one  end  of  the  camp; 
next  to  this  should  be  the  eating  quarters,  then  the 
sleeping  quartei-s,  then  the  toUets  for  the  men,  then  the 
stable,  thus  bringing  the  kitchen  and  the  stable  at 
opposite  ends  of  the  camp,  which  should  be  as  far  apart 
as  is  consistent  with  the  natural  topography  and  the 
necessity  for  convenient  access. 

Sec  77.  Water  supplies. — AU  water  supplies  for 
camps  shall  be  properly  chlorinated,  unless  obtained 
from  a  source  which  has  been  approved  by  the  State 
department  of  health. 

Sec.  78.  Water  containers. — All  drinking-water  con- 
tainers in  camps  shall  be  securely  closed  and  so  ar- 
ranged that  water  can  be  drawn  only  from  a  tap,  and 
said  containers  shall  be  kept  clean  and  free  from  con- 
tamination. 

Sec.  79.  Garbage  and  refuse. — AU  garbage,  kitchen 
wastes,  and  other  rubbish  in  camps  shall  be  deposited 
in  suitably  covered  receptacles,  the  contents  of  which 
shaU  be  emptied  and  burned  each  day;  and  manure 
from  the  stables  shaU  be  likewise  collected  and  burned 
each  day,  or  disposed  of  in  some  other  manner  ap- 
proved by  the  State  department  of  health. 

Sec.  80.  Scavenger. — In  aU  camps  where  there  are 
100  men  or  more  there  shall  be  1  employee  whose 
duty  shall  be  to  act  as  scavenger  and  garbage  collector. 

Sec  81.  Toilets. — Every  camp  shall  have  an  ade- 
quate number  of  latrines  and  urinals,  so  constructed 
and  maintained  as  to  prevent  fly  breeding  and  the  pol- 
lution of  water,  and  the  use  of  such  latrines  and  urinals 
by  the  inhabitants  of  the  camp  shall  be  made  obliga- 
tory. Latrines  and  urinals  may  consist  of  deep 
trenches  covered  with  houses  adequately  screened 
against  flies,  or  of  any  other  type  approved  by  the 
State  department  of  health.  They  shall  not  be  located 
within  less  than  200  feet  of  any  spring,  stream,  lake, 
or  reservoir  forming  part  of  a  public  or  private  water 
supply. 


72 


RECOMMENDATIONS   OF    COMMITTEE    ON    HEAI^TH   AND    MEDICAL   RELIEF. 


Sec.  82.  Bathing  facilities. — There  shall  be  pro- 
vided in  all  camps  adequate  bathing  facilities  for  the 
use  of  the  occupants  thereof. 

Sec  83.  Screening. — The  kitchen,  eating  houses,  and 
bunk  houses  of  aU  camps  shall  be  effectively  screened 
against  the  entrance  of  flies  and  mosquitoes  during  the 
seasons  of  flight  of  these  insects. 

Sec.  84.  Care  to  tableware. — All  cooking,  table, 
and  kitchen  utensils,  drinking  glasses,  and  crockery 
used  in  the  preparation  or  serving  of  food  or  drink  in 
camps  shall  be  thoroughly  washed  in  boiling  water  and 
suitable  cleansing  material  after  each  time  they  are 
used. 

Sec.  8.5.  Food  containers. — Refrigerators,  food  boxes, 
or  other  receptacles  for  the  storing  of  fresh  food  iii 
camps  shall  be  emptied  and  thoroughly  washed  with 
soap  and  hot  water  and  treated  with  a  1  to  3,000  solu- 
tion of  permanganate  of  potash  or  other  approved 
deodorant  at  least  once  in  each  seven  days  that  they 
are  in  use. 

vSec.  86.  Food  and  milk. — No  spoiled  or  tainted  food, 
whether  cooked  or  uncooked,  shall  be  served  in  any 
camp;  and  no  milk  or  milk  products  shall  be  served 
unless  the  milk  has  been  pasteurized  or  boiled. 

Sec:  87.  Examination  of  food  handlers. — No  person 
shall  be  employed  as  a  cook,  waiter,  or  in  any  other 
capacity  in  the  preparation  or  serving  of  food  in  any 
camp  who  is  known  or  suspected  to  have  any  danger- 
ous commimicable  disease;  and  all  persons  so  em- 
ployed shall  undergo  a  physical  examination  by  a  com- 
petent physician  before  being  assigned  to  service,  and 
before  retm'ning  to  work  after  any  disabling  illness, 
to  determine  their  freedom  from  such  diseases,  and 
shall  be  immediately  relieved  from  service  if  found  to 
be  so  afflicted.  There  shall  be  a  monthly  medical  in- 
spection for  dangerous  communicable  diseases.  To  de- 
termine persons  afflicted  with,  or  carriers  of,  typhoid 
fever,  tuberculosis,  dysentery,  diphtheria,  streptococic 
sore  throat,  scarlet  fever,  gonorrhea,  syphilis,  etc.,  a 
laboratory  examination  shall  be  made  if  necessary. 

vSec.  88.  Sick  persons. — When  an  occupant  of  a 
camp  becomes  sick  with  a  dangerous  communicable 
disease,  he  should  be  immediately  isolated  and  not 
released  until  declared  by  a  proper  health  authority 
to  be  free  from  dangerous  infection. 

Sec.  89.  Vermin. —  It  shall  be  the  duty  of  some  one 
appointed  as  caretaker  of  the  camp  to  make  regular 
weekly  inspections  of  the  occupants  and  premises  in 
order  to  ascertain  the  presence  of  lice  or  other  vermin. 
Persons  found  to  be  infested  shall  be  required  to  bathe, 
and  their  clothing  shall  be  boiled;  and  premises  found 
to  be  infested  shall  be  fumigated  with  solphur  or 
treated  by  some  other  effective  vermin-destroying 
method. 

Sec.  90.  Abandoned  camp.'j. — When  any  camp  is  to 
be  abandoned,  all  garbage,  rubbish,  and  manure  shall 
be  collected  and  burned,  the  latrine  trenches  filled, 


and  the  grounds  and  buildings  shall  be  left  in  a  clean 
and  sanitary  condition. 

Sec.  91.  Duty  to  enforce  regulations. — It  shall  be 
the  duty  of  the  superintendent,  foreman,  or  other 
person  in  charge  of  a  camp  to  see  that  all  regulations 
pertaining  thereto  are  faithfully  complied  with. 

VII.     Offices. 

Sec.  92.  Definition. — For  the  purposes  of  these 
regulations  offices  shall  be  considered  to  include  all 
buildings  or  parts  of  buildings  occupied  or  used  as  the 
offices,  headquarters,  or  working  spaces  of  the  cler- 
ical administrative,  or  executive  forces  of  railways  or 
other  common  carriers. 

Sec.  93.  Space. — AU  offices  shall  contain  not  less  than 
400  cubic  feet  of  space  for  each  occupant. 

Sec.  94.  Ventilation,  heat,  and  light. — All  offices 
when  occupied  shall  be  provided  with  an  adequate 
supply  of  fresh  air,  heat,  and.  light  for  the  mainte- 
nance of  healthful  and  comfortablfe  working  conditions. 
Any  measures  taken  to  assure  continuous  ventilation 
during  working  hours  should  be  supplemented  by  the 
opening  of  doors  and  windows  for  at  least  five  minutes 
before  the  beginning  of  morning  and  afternoon  work 
periods  and  once  during  each  of  such  periods.  When 
artificial  heat  is  necessary,  the  temperature  should  not 
exceed  70°  F.  Window  space  should  be  sufficient  to 
allow  of  the  use  of  natural  skylight  in  all  parts  of  offices 
during  the  brighter  parts  of  the  day,  and  when  arti- 
ficial lights  are  used  they  should  be  so  arranged  and 
shaded  as  to  prevent  direct  glare. 

Sec.  95.  Cleaning. — All  offices,  together  with  the 
corridors,  stairs,  or  passageways  leading  to  them, 
shall  be  swept  and  dusted  daily;  and  at  intervals  of 
not  more  than  seven  days  the  floors  shall  be  scrubbed 
with  soap  and  water,  and  the  woodwork  and  furniture 
rubbed  clean  with  a  cloth  moistened  with  water  or  oil. 
Cleaning  shall  not  be  carried  on  while  offices  are  occu- 
pied by  employees,  except  in  offices  wliich  are  occupied 
continuously;  and  in  such  case  sweeping  may  be  done 
only  after  the  floor  has  been  sprinkled  with  wet  saw- 
dust or  other  dust-absorbing  material,  and  dusting 
only  with  a  cloth  moistened  with  water  or  oil. 

Sec.  96.  Window  cleaning. — Office  windows  shall 
be  washed  or  otherwise  cleaned  at  such  intervals  as 
will  assure  a  free  and  uninterrupted  flow  of  light  to 
office  interiors,  and  in  no  case  shaU  such  cleaning  be 
less  frequent  than  once  in  each  month. 

Sec.  97.  Telephones. — Telephone  earpieces  and 
mouthpieces  should  be  cleaned  with  soap  and  water 
at  least  once  in  each  week. 

Sec.  98.  Spitting. — Spitting  on  the  floors,  walls, 
stairways,  or  other  parts  of  offices  or  office  buildings 
is  prohibited. 

Sec.  99.  Cuspidors. — If  cuspidors  are  provided  in 
offices  or  office  buildings  they  shaU  be  cleaned  daily, 
and  oftener  if  their  condition  requires. 


EECOMMENDATIONS   OF   COMMITTEK    ON    HEALTH   AND   MEDICAL   RELIEF. 


Sec.  100.  Toilets.— All  ofl3.ces  and  office  buildings 
shall  be  provided  with  adequate  toilet  and  lavatory 
facilities  of  an  approved  sanitary  type,  conveniently 
located  for  the  use  of  employees;  and  wher.e  members 
of  both  sexes  are  employed,  separate  toilets  shall  be 
maintained  for  each  sex.  Where  a  sewer  is  available, 
toilets  shall  be  of  the  water-flushing  type  and  per- 
manently connected  thereto. 

Sec.  101.  Care  of  toilets. — All  toilets  installed  as  set 
forth  in  section  100  shall  be  kept  in  repair  and  in  good 
working  order,  and  shall  be  cleaned  daily  by  scrubbing 
the  floors,  bowls,  and  seats  with  soap  and  water. 
When  offensive  odors  appear  in  toilets  which  are  not 
obliterated  and  removed  by  cleaning  as  above  set 
forth,  said  toilets  shall  be  treated  with  a  1  per  cent 
solution  of  formaldehyde  or  other  odor-destroying  sub- 
stance. 

Sec.  102.  Toilet  supplies. — Toilets  and  lavatories 
installed  as  set  forth  in  section  100  shall  be  furnished 
with  an  adequate  supply  of  toilet  paper,  soap,  and 
clean  towels. 

Sec.  103.  Common  towels. — The  supplying  of  roller 
towels  or  other  towels  for  common  use  in  offices  or 
office  buildings  of  common  carriers  is  prohibited. 

Sec.  104.  Combs  and  brushes. — The  supplying  of 
combs  and  brushes  for  common  use  in  offices  or  office 
buildings  of  common  carriers  is  prohibited. 

Sec.  105.  Common  cups. — Individual  drinking  cups 
in  sufficient  number  shall  be  supplied  in  the  offices  of 
common  carriers,  and  the  use  of  common  drinking  cups 
is  prohibited. 

Sec.  106.  Drinking  water  and  ice. — If  the  drinking 
water  provided  in  offices  or  office  buildings  of  common 
carriers  is  not  obtained  from  an  approved  municipal 
supply,  or  is  not  distilled  or  otherwise  sterilized  before 
being  used,  it  shall  be  subject  to  the  conditions  set 
forth  in  section  11  of  these  regulations.  Ice  used  for 
cooling  drinking  water  shall  be  subject  to  the  condi- 
tions set  forth  in  section  12  of  these  regulations;  and 
drinking-water  containers  shall  be  subject  to  the  con- 
ditions setforth  in  sections  13, 14,  and  15  of  these  regu- 
lations. ,.■{, 

Sec.  107.  Drinking  fountains. — If  drinking  foun- 
tains of  the  bubbling  type  are  provided  in  the  offices  or 
office  buildings  of  common  carriers,  tliey  shall  be  so 
made  that  the  drinking  is  from  a  free  jet  projected  at 
an  angle  to  the  vertical,  and  not  from  a  jet  that  is  pro- 
jected vertically  or  that  flows  through  a  filled  cup  or 
bowl. 

Sec.  108.  Lockers. — If  lockers  are  supplied  for  the 
use  of  employees,  tliey  shall  be  kept  clean  and  free  from 
discarded  clothing.  ,,,,,. 

Sec.  109.  Eest  rooms. — A  rest  room  shall  be  pro- 
vider! in  all  offices  or  office  buildings  of  common  carriers 
where  100  or  more  women  are  employed;  and  such 
room  is  desirable  where  any  smaller  number  of  women 
are  employed. 


Seg.  110.  Communicable  diseases. — Wlien  an  em- 
ployee who  is  convalescent  from  a  communicable  dis- 
ease reports  for  duty,  such  employee  shall  not  be  allow- 
ed to  resume  work  until  a  satisfactory  certificate  or 
release  from  the  health  officer  having  jurisdiction  has 
been  secured  stating  that  there  is  no  remaining  danger 
of  his  communicating  disease  to  other  people. 

VIII.  Shops. 

Sec.  111.  Toilet  facilities. — All  repair,  constructing, 
or  other  shops  of  common  carriers  shall  be  provided 
with  adequate  toiletfacilitiesfor  the  use  of  the  employ- 
ees; and  if  both  men  and  women  are  employed,  such 
facilities  shall  be  separate  for  the  two  sexes.  Wliere 
running  water  and  sewers  are  available,  all  toilet  fix- 
tures shall  be  permanently  connected  thereto. 

Sec.  112.  Type  of  water-closets. — Water-closets 
should  be  of  the  individual  bowl  type  with  individual 
water  seal;  flush  range  closets  shall  not  be  used. 
The  seats  should  be  wood  or  other  poor  conducting 
material,  and  should  be  rendered  impervious  to  water 
by  coating  with  varnish  or  by  other  means.  The  seats 
should  be  of  the  cut-out-front  type,  or  if  closed  in 
front,  the  openings  should  be  at  least  7  inches  wide 
by  11  inches  long. 

Sec.  113.  Closet  inclosures. — The  separate  seats  of 
ivater-closets  shall  be  so  inclosed  as  to  secure  privacy 
for  the  users.  Between  the  seats  there  should  be 
partitions  about  6  feet  high  and  12  inches  off  the  floor, 
and  each  inclosure  should  have  a  swinging  door  of 
proper  height.  Each  inclosure  should  have  not  less 
than  10  square  feet  of  floor  space  and  not  less  than  100 
cubic  feet  of  air  sjiace,  and  the  walls  and  partitions 
should  be  of  light  color  to  increase  illumination  and 
facilitate  cleaning.  The  floors  shoidd  be  of  tile  or 
concrete  with  a  smooth  surface  and  should  be  non- 
absorbent. 

Sec.  114.  Windows  in  toilet  rooms. — All  toilet  rooms 
containing  water-closets  should  be  open  to  outside 
light  and  air.  The  minimimi  window  space  for  a 
room  containing  one  closet  fixture  should  be  four 
square  feet,  and  for  each  additional  fixture  there 
should  be  an  addition  of  two  square  feet  of  window 
space.  Windows  should  be  so  arranged  that  they  can 
be  opened  for  affording  free  ventilation. 

Sec.  115.  Equipment  of  closets. — All  closet  in- 
closures shall  be  equipped  with  clothes  hooks  and 
with  a  plentiful  supply  of  toilet  paper  with  proper 
holder. 

Sec.  116.  Type  of  urinals. — Urinals  should  be  of  the 
vertical  slab  or  the  porcelain  stall  type  with  proper 
flushing;  troughs  or  basins  shall  not  be  used  for  this 
purpose.  There  should  be  protection  around  urinals 
to  secure  privacy.  The  floor  in  front  of  the  urinal 
should  be  impervious  and  nonabsorbent  and  should 
slope  to  drain. 


74 


BECOMMENDATIONS   OF    COMMITTEE    ON   HEALTH   AND   MEDICAL   RELIEF. 


Sec.  117.  Care  of  closets  and  urinals. — All  water- 
closets  and  urinals,  together  with  the  floors,  bowls, 
and  seats,  shall  be  kept  in  a  reasonably  clean  and  sani- 
tary condition  at  aU  times.  They  should  be  cleaned 
by  scrubbing  with  soap  and  water  daily,  and  when 
offensive  odors  develop  which  are  not  removed  by  such 
cleaning,  they  should  be  treated  with  a  1  per  cent  for- 
maldehyde solution  or  other  odor-destroying  sub- 
stance. 

Sec.  118.  Number  of  closets  and  urinals. — Closets 
should  be  installed  in  the  proportion  of  1  to  each  25 
employees  on  any  one  shift;  and  urinals  should  be  in- 
stalled in  the  proportion  of  one  to  each  50  male  em- 
ployees on  any  one  shift. 

Sec.  119.  Location  of  closets  and  urinals. — Closets 
and  urinals  should  be  located  as  conveniently  as  pos- 
sible to  work.  There  should  be  a  number  of  small  in- 
stallations rather  than  a  few  larger  ones. 

Sec.  120.  Privies. — Where  water  and  sewer  connec- 
tions are  not  available,  sanitary  privies  of  a  type  ap- 
proved by  the  State  department  of  health  shall  be 
provided,  with  a  ratio  of  not  less  than  1  seat  to  each  25 
employees  on  any  one  shift.  They  shall  be  adequately 
protected  against  the  entrance  of  flies,  and  shall 
be  kept  in  a  clean  and  sanitary  condition  at  aU  times. 
The  vaults  shall  be  treated  with  caustic  soda  or  other 
approved  disinfectant  at  intervals  of  not  more  than 
seven  days,  and  shall  be  emptied  at  such  intervals  as 
wiU  avoid  the  development  of  a  nuisance. 

Sec.  121.  Wash  rooms  and  lockers. — Ample  washing 
facilities  and  locker  space  shall  be  provided  for  em- 
ployees. If  possible,  wash  rooms  and  locker  rooms 
should  be  along  the  routes  of  employees  when  going 
from  work,  and  so  located  as  to  avoid  undue  hazard  or 
exposure  to  the  weather  in  reaching  them.  They 
should  be  separated  from  toilet  rooms  by  partitions 
or  otherwise,  and  should  open  to  outside  light  and  air. 
Sufficient  window  space  should  be  provided  to  afford 
adequate  light  and  ventilation. 

Sec.  122.  Type  of  wash  rooni  fixtures. — Facilities 
for  washing  should  be  either  so  constructed  that  the 
users  must  necessarily  wash  from  a  flowing  stream,  or 
individual  basins;  and  no  large  basins  or  troughs  for 
common  use  should  be  installed.  Both  hot  and  cold 
water,  delivered  through  a  common  discharge  pipe, 
should  be  supplied  to  each  fixture.  Soap  should  be 
provided;  and  fixtures  should  be  so  spaced  that  a  man 
can  wash  without  splashing  his  neighbor. 

Sec.  123.  Finish  of  wash  floors. — The  floors  of  wash 
rooms  should  be  of  concrete  or  other  nonabsorbent 
material  and  should  slope  toward  central  drains.  The 
walls,  ceilings,  and  partitions  should  be  light  in  color 
to  increase  illumination  and  to  facihtate  cleaning,  and 
the  rooms  should  be  adequately  lighted  artificially  so 
that  no  dark  corners  will  exist. 

Sec.  124.  lockers. — A  locker  or  other  provision  for 
caring  for  a  change  of  clothing  shall  be  supphed  for 
each  employee  who  has  a  fixed  place  of  work.     Lockers 


should  be  elevated  at  least  4  inches  off  the  floor,  should 
be  not  less  than  12  by  15  inches  in  floor  dimensions,  and 
should  be  ventilated  by  perforated  doors  or  otherwise. 

Sec.  125.  Bathing  facilities. — Shower  baths  shall 
be  provided  in  the  proportion  of  1  to  each  25  employees 
for  all  employees  who  work  with  lead,  paint,  or  in 
very  dusty  or  dirty  places.  They  should  be  located 
adjoining  locker  rooms,  should  be  inclosed  so  as  to  af- 
ford privacy,  and  should  be  supplied  with  hot  and 
cold  water  delivered  through  a  common  discharge 
pipe.  The  floors  should  be  of  concrete  or  other  non- 
absorbent  material  and  should  slope  to  a  central  drain. 

Sec.  126.  Caretakers. — There  shall  be  caretakers  in 
sufficient  number  responsible  for  the  cleaning,  sup- 
plying, and  upkeep  of  toilets,  wash  rooms,  and  locker 
rooms. 

Sec.  127.  lighting. — In  all  shops  and  parts  of  shops 
there  shall  be  an  adequate  amount  of  light  for  the 
occupation  or  process  being  carried  on  therein;  and 
the  glare  of  direct  light  passing  from  unshaded  sources 
directly  to  the  eyes  of  workers  should  be  avoided. 
Wherever  shops  are  dependent  upon  window  lighting, 
the  glass  shall  be  kept  clean. 

Sec.  128.  Water  supplies. — An  adequate  supply 
of  drinking  water,  conveniently  located  for  the  use 
of  employees,  shall  be  supplied  in  aU  shops.  If  the 
drinking  water  provided  is  not  obtained  from  an 
approved  municipal  supply,  or  is  not  distilled  or 
otherwise  sterilized  before  being  used,  it  shall  be 
subject  to  the  conditions  set  forth  in  section  11  of  these 
regulations.  Ice  used  for  cooling  drinking  water 
shall  be  subject  to  the  conditions  ret  forth  in  section  12 
of  these  regulations,  and  drinking-water  containers 
shall  be  subject  to  sections  13,  14,  and  15  of  these 
regulations. 

Sec.  129.  Drinking  fountains. — If  drinking  foimtains 
of  the  bubbling  type  are  provided,  they  shall  be  so 
made  that  the  drinking  is  from  a  free  jet  projected 
at  an  angle  to  the  vertical,  and  not  from  a  jet  that 
is  projected  vertically  or  that  flows  through  a  filled 
cup  or  bowl. 

Sec.  130.  Common  cups. — The  use  or  supplying  of 
drinking  cups  for  the  common  use  of  employees  is 
prohibited. 

Sec.  131.  Common  towels. — The  use  or  supplying  of 
roller  towels  or  other  towels  for  the  common  use  of 
employees  is  prohibited. 

Sec.  132.  Rest  rooms. — A  rest  room  shall  be  pro- 
vided in  all  shops  where  100  or  more  women  are  em- 
ployed; and  such  room  is  desirable  where  any  smaller 
number  of  women  are  employed. 

Sec.  133.  Communicable  diseases. — When  an  em- 
ployee who  is  convalescent  from  a  communicable  dis- 
ease reports  for  duty,  such  employee  shall  not  be 
allowed  to  resume  work  until  a  satisfactory  certificate 
or  release  from  the  health  officer  having  jurisdiction 
has  been  secured  stating  that  there  is  no  remaining 
danger  of  his  communicating  disease  to  other  people. 


recommendations  of  committee  on  health  and  medical  relief. 
Exhibit  E. 


75 


GENERAL  AND  DEPARTMENTAL  RULES  GOVERNING  PHYSICAL  EXAMINATIONS  OF  APPLICANTS 
FOR  EMPLOYMENT,  PROMOTION,  AND  PERIODIC  EXAMINATION  IN  ORDER  TO  DETERMINE 
THEIR  FITNESS  FOR  SERVICE,  AS  RECOMMENDED    BY  COMMITTEE. 


GENERAL  RULES.  * 

1.  The  essential  qualifications  for  various  positions 
shall  be  determined  by  the  examinations  herein  pre- 
scribed. 

2.  Examinations'  shall  not  be  made  when  a  can- 
didate has  just  come  in  from  a  run  or  been  subjected 
to  unusual  fatigue. 

3.  Candidates  for  employment  or  selected  for  pro- 
motion shall  pass  the  required  examinations  and  tests 
before  being  permitted  to  enter  upon  the  duties  of 
the  position  sought. 

4.  The  general  mental  characteristics  and  bearing 
of  the  candidate,  such  as  confident,  diffident,  bright, 
dull,  quick,  slow,  etc.,  shall  be  noted  on  the  applica- 
tion blank  by  the  examiner. 

5.  Reexaminations  may  be  ordered  at  any  time  by 
proper  authority. 

6.  Applications  shall  be  approved  or  rejected  by 
proper  authority. 

7.  The  various  roads  shall  prescribe  a  form  which 
will  properly  take  care  of  examination  records. 

8.  The  date  of  reexamination  shall  be  computed 
from  the  time  of  the  last  physical  examination.  If 
there  has  been  no  previous  physical  examination,  the 
date  of  reexamination  shall  be  computed  from  the 
date  these  regulations  become  effective. 

9.  If  an  employee  subject  to  reexamination  is 
relieved  from  service  or  his  service  changed  as  a  result 
of  the  examining  physician's  findings,  he  may  appeal 
to  a  medical  board  composed  of  one  physician  chosen 
by  the  railroad  and  one  by  the  employee ;  if  this  board 
fails  to  agree,  it  shall  select  a  third  member.  The 
members  of  the  board  shall  be  men  of  good  standing  in 
the  community  and  of  recognized  professional  ability. 
The  expense  of  examination  shall  be  assumed  by  the 
railroad.  The  findings  of  the  board  shall  be  considered 
as  final  and  submitted  to  the  proper  authorities. 

10.  Employees  when  examined  for  promotion  or 
periodically  are  found  to  have  any  of  the  disqualifying 
defects  applying  to  applicants  for  service,  a  full  report 
of  such  defect  or  defects  shall  be  made  to  officer  to 
whom  the  examiner  reports.  No  such  employee  shall 
be  relieved  from  service  without  the  approval  of  the 
general  manager  or  his  accredited  representative. 

*A  physical  examination  may  be  made  at  any  time  on  request 
of  the  employing  officer,  the  employee,  or  on  written  request  of 
three  fellow  employees. 


DEPARTMENTAL  RULES. 

Transportation  Department. 

AGE  limit. 

11.  With  the  exception  of  clerks,  messengers,  and 
call  boys,  the  minimum  ago  shall  be  21  years,  maxi- 
mum 45  years. 

12.  The  ma.ximum  age  for  inexperienced  applicants 
for  positions  as  firemen  or  brakemen  shall  be  3.5  years. 

PHYSICAL  EXAMINATION. 

13.  Applicants  for  service  shall  undergo  a  phj-sical 
examination  including  vision  and  hearing.  Appli- 
cants for  train  service  and  for  other  positions  connected 
in  any  manner  with  the  operation  of  trains  shaU  in 
addition  pass  a  satisfactorj^  examination  on  colors. 

14.  Examining  physicians  shall  recommend  for 
rejection  applicants  whose  hearing  and  vision  (and 
color  sense  when  required)  do  not  conform  to  stand- 
ard, or  who  are  found  to  be  physically  or  mentally 
unfit. 

PROMOTION. 

15.  Employees  before  being  promoted  shall  undergo 
a  physical  examination  including  vision  and  hearing, 
and  in  certain  classes  as  covered  by  rule  17  also  shall 
pass  a  satisfactory  examination  on  colors. 

PERIODIC  PHYSICAL  EXAMINATION. 

16.  Employees  in  train  service  or  holding  other 
positions  in  any  manner  connected  with  the  operation 
of  trains  shall  undergo  a  physical  examination  includ- 
ing vision,  hearing,  and  colors  at  least  every  five 
years. 

17.  Employees  who  are  45  years  of  age  or  over  in 
train  service  or  holding  other  positions  in  any  manner 
connected  with  the  operation  of  trains  shall  undergo 
a  physical  examination  including  vision,  hearing,  and 
colors  every  two  years. 

Maintenance  of  Way  Department. 
age  limit. 

18.  With  the  exception  of  clerks,  water  boys, 
and  messengers,  the  minimum  age  shaU  be  18  years, 
maximum  45  years. 

PHYSICAL  EXAMINATION. 

19.  Applicants  for  service  shall  undergo  a  physical 
examination  including  vision  and  hearing.  Appli- 
cants for  positions  connected  in  any  manner  with  the 
operation  of  trains  shall  in  addition  pass  a  satisfactory 
examination  on  colors. 


76 


RECOMMENDATIONS   OF    COMMITTEE   OW    HEALTH   AND   MEDICAL  RELIEF. 


20.  Examining  physicians  shall  recommend  for 
rejection  applicants  whose  hearing  and  vision  (and 
color  sense  when  required)  do  not  conform  to  standa,rd, 
or  who  are  found  to  be  physically  or  mentally  unfit. 

PROMOTION. 

21.  Employees  promoted  to  positions  comiected  in 
any  manner  with  the  operation  of  trains  shall  undergo 
a  physical  examination  including  vision,  hearing,  and 
colors. 

PERIODIC    PHYSICAL    EXAMINATION. 

22.  Employees  connected  in  any  manner  with  the 
operation  of  trains  shall  undergo  a  physical  examina- 
tion at  least  every  5  years,  including  vision,  hearing, 
and  colors. 

23.  Employees  who  are  45  years  of  age  or  over  con- 
nected in  any  manner  with  the  operation  of  trains 
shall  undergo  a  physical  examination,  including  vision, 
hearing,  and  colors  every  two  years. 

Maintenance  of  Equipment  Department. 

[Does  not  apply  during  the  existence  of  the  agreement  between 
the  United  States  Railroad  Administration  and  the  Railway  Em- 
ployees Department  of  the  American  Federation  of  Labor,  Me- 
chanical Section,  and  Divisions  Nos.  1.  2,  and  3,  because  of  rule  46.] 

AGE    LIMIT. 

24.  With  the  exception  of  clerks,  messengers,  call 
boys,  and  apprentices,  the  minimum  age  shall  be  IS 
years,  maximum  45  years. 

PHYSICAL    examination. 

25.  Applicants  for  service  shall  undergo  a  physical 
examination,  including  vision  and  hearing.  Appli- 
cants for  positions  connected  in  any  manner  with  the 
operation  of  trains  shall  in  addition  pass  a  satisfactory 
examination  on  colors. 

26.  Examining  physicians  shall  recommend  for  re- 
jection applicants  whose  hearing  and  vision  (and  color 
sense  when  required)  do  not  conform  to  standard,  or 
who  are  found  to  be  physically  or  mentally  unfit. 

promotion. 

27.  Employees  promoted  to  positions  connected  in 
any  manner  with  the  operation  of  trains  shall  undergo 
a  physical  examination,  including  vision,  hearing,  and 
colors. 

28.  Employees  who  by  nature  of  their  employment 
might  because  of  sudden  physical  incapacity  endanger 
the  lives  of  fellow  employees  shall  undergo  a  physical 
examination. 

periodic  physical  examination. 

29.  Employees  connected  in  any  manner  with  the 
operation  of  trains  shall  undergo  a  physical  examina- 
tion at  least  every  five  years,  including  vision,  hear- 
ing, and  colors. 

30.  Employees  who  by  nature  of  their  employment 
might  by  sudden  physical  incapacity  endanger  the 
lives  of  other  employees  shall  undergo  a  physical  exami- 
nation at  least  every  five  years. 


31.  Employees  subject  to  examination  for  promo- 
tion and  periodic  examination  who  are  45  years  of  age 
or  over  shall  undergo  a  physical  examination  at  least 
every  two  years. 

RULES  GOVERNING  VISION  EXAMINATION. 

32.  A  set  of  at  least  two  standard  cards  of  Snellen's 
test  letters  showing  letters  of  various  sizes  from  20  to  70, 
inclusive.  The  letters  to  be  arranged  in  different 
order  in  the  corresponding  lines  of  each  card. 

33.  A  standard  reading  test  card  with  matter 
printed  in  various  type. 

34.  A  test  spectacle  frame  with  opaque  disk. 

Note. — The  following  may  be  used  if  desii'ed:  A  set  of  test 
cards  showing  semaphores  in  various  positions. 

Method  of  Testing, 
letter  card  test. 

Place  the  candidate  to  be  examined  so  that  he  will 
not  face  a  strong  light;  cover  one  of  his  eyes  with 
opaque  disk  in  test  frame ;  place  one  of  the  cards  at  a 
distance  of  20  feet  from  him,  in  a  clear  light,  but  not 
in  direct  sunlight,  and  direct  him  to  read  the  letters 
on  certain  lines  as  selected  by  the  examiner,  including 
the  line  marked  20.  A  portion  of  the  test  card  may  be 
covered  and  the  candidate  required  to  read  the  re- 
mainder of  the  line  of  letters,  or  certain  letters  at  each 
end  of  the  line  may  be  covered  and  the  candidate  re- 
quired to  read  the  intervening  letters.  If  he  can  read 
the  letters  on  the  line  marked  20  correctly,  substitute 
another  card  with  a  different  arrangement  of  letters 
and  test  in  a  similar  manner.  If  he  reads  the  letters 
on  the  line  marked  20  on  both  cards  correctly,  it  indi- 
cates normal  vision.  If  he  can  not  read  the  letters  on 
the  line  marked  20,  direct  him  to  read  the  lines  above 
20  successively  until  a  line  is  found  which  he  can  read. 

Record  in  fractions  the  acuteness  of  vision  as  deter- 
mined, the  numerator  being  20  (the  distance  at  which 
the  card  is  placed)  and  the  denominator  the  number  on 
the  card  showing  the  smallest  sized  letters  that  he  has 
read  correctly.  Repeat  this  test  with  the  other  eye 
and  record  the  results.  Mistakes  of  not  more  than 
tliree  letters  on  the  20  line;  two  letters  on  the  30  line; 
and  one  letter  on  the  40  line  will  be  considered  as  a 
satisfactory  reading.  Other  lines  must  be  read  with- 
out error. 

READING    CARD    TEST. 

Direct  the  candidate  to  read  certain  letters  or  sen- 
tences from  the  standard  reading  test  card  and  record 
the  smallest  size  of  print  read  correctly  at  the  ordinary 
distance  of  from  14  to  18  inches.  A  portion  of  the  test 
card  may  be  covered  and  the  candidate  required  to 
read  the  remainder  of  the  paragraph.  The  candidate 
should  be  able  to  read  the  print  in  paragraph  two  of 
the  standard  card  to  pass  the  test  satisfactorily.  This 
test  should  be  made  without  glasses  except  at  the  age 
or  under  the  coiaditions  where  the  use  of  glasses  is  per- 
mitted. 


EEGOMMENDATIONS   OK    COMMITTEE   ON    HEALTH    AN]J    MEIJICAL  RELIEF 
VISUAL  STANDARDS. 


77 


Occupation. 


Enginemen   and    fiiemcn.    road 
service. 


Engiuenien   and   firemen,    yard 
service. 


Passenger  coiidiick)r.s,  passenger 
brakemen,  passenger  baggage 
masters,  yard  conductors,  yard 
brakemen,  freight  conductors, 
freight  brakemen,  flagmen. 


To  enter  service. 


20/20  in  each  eye  tested  sepa- 
rately, without  gla.sses. 


20/20   in   cacli    rye.    lesled   .-^cpa- 
ralclv.  withoul  glasses. 


'l"o  be  promoted. 


20/20  in  one  eye  and  nol  less 
tlian  20/:W  in  "the  other.  teste<i 
sei^arately.    with    or   witliout 

glasses. 


Hee.xani  illation 


Not  less  than  20  :i0  in  cii'-b 
will)  or  •without  gl£u<s<"^ 


20/20  in  one  eye  and  uoi  le.s.^  ,  Xi.i,  le.s-  iliaii  20  :;o  in  on.-  i- 
than  20/80  in  the  other,  with  and  20'40  in  the  oilier,  with 
or  without  gla.sses.  without  gla.sses 


20/2(1  in  one  eye  and  uot  less 
tlian  20/80  in'the  other,  with- 
out gla.sses. 


Not  less  than  20'30  in  one  eye 
and  20/40  in  the  other,  with 
or  without  gla-^ses. 


Not  less  than  20/40  in  each  ey< 

with  or  without  gla.s.se<. 


Road  foremen  of  engines,  yard     Not  less  than  20/30  in  one  eye 
masters,    telegraph   ojierators.         and  20/40  in  the  other,  witli  or 


Not  less  tlian  20/40  in  each  eye.      Not  less  than  20/40  in  each  ey( 
with  or  without  glasses.  witli  or  without  glasses. 


station  agents"     section     fore- 
men,   assistant    section    I'ore- 
raen,   switch   tenders,    signal- 
men, lampmen.  hostlers. 

without  glasses. 

Car  inspectors,  engine  inspectors . 

Not  less  than  20/80  in  one  eye 
and  20/40  in  the  other,  with 
or  without  glasses. 

with  or  without  glasses. 

Not  less  than  20/40  in  eacli  eye. 
with  or  without  glasses. 

Not  less  than  20/40  in  one  eye  and 

20 '50   in    the    other,    ivith    or 
without  glasses. 

35.  Applicants  for  service  not  noted  in  above 
classification  whose  vision  with  or  without  glasses  is 
not  less  than  20/40  in  one  eye  and  20/50  in  the 
other  may  be  recommended  for  acceptance  for  service 
if  not  banned  by  any  other  physical  or  mental  defect. 

36.  The  above  standards  will  be  considered  sat- 
isfactory for  employees  in  classes  mentioned.  Ex- 
ceptions can  be  made  only  by  authority  of  the  general 
manager. 

37.  It  is  compulsory  for  employees  requiring  glasses 
to  bring  their  vision  up  to  recjuired  standard,  to  wear 
their  glasses  while  oit  duty,  and  to  have  an  extra  pair 
of  glasses  with  them. 

BULES  GOVERNING  COLOR  PERCEPTION. 

38."  A  set  of  Holmgren  color  test  worsteds,  or  equal, 
and  in  doubtful  cases,  a  Williams  lantern,  or  its  eqtial. 

Method  of  Testing. 

Place  the  whole  number  of  colored  worsteds  on  a 
table  in  good,  clear  daylight.  Put  the  test  skein 
"  light-gi-een "  at  a  distance  of  about  2  feet  from  the 
other  colors,  and  ask  the  candidate  being  examined 
to  select  from  the  heap  of  colors  all  that  look  to  him 
like  the  test  skein,  and  place  them  beside  it.  Have 
him  understand  that  he  is  not  expected  to  find  an 
exact  match  for  the  test  skein,  but  that  he  is  to  choose 
all  the  colors  that  appear  to  him  of  tht^  same  general 
color  as  the  test  skein,  both  those  that  are  lighter  and 


those  that  are  darker  in  shade.  If  he  does  not  easily 
understand  what  is  wanted,  let  the  examiner  himself 
select  the  colors;  then,  having  returned  them  to  the 
general  heap  and  mixed  them  thoroughly  wdth  the 
rest  of  the  colors,  let  him  call  on  the  candidate  being 
examined  to  repeat  the  selection.  This  demonstra- 
tion will  not  enable  a  candidate  who  is  defective  in 
his  color  perception  to  select  the  colors  coiTectly,  and 
he  may  pick  out  as  looking  to  hrm  like  the  test  skein 
"light-green"  some  of  the  greens  and  also  some  of 
the  gray  or  brown  confusion  colors,  which  wiU  appear 
to  him  of  the  same  general  color  as  the  test  skem, 
only  varying  from  it  in  shade.  Record  the  number 
of  the  colors  incorrectly  selected  as  beuig  similar  to  the 
test  skein  ''light-green,"  and  also  note  whether  the 
selection  is  prompt  or  hesitating,  by  writing  the  letter 
"P"  or  "H"  on  the  line  opposite  each  of  the  names 
of  the  colors  as  printed.  Return  all  the  colors  to  the 
heap  and  mix  them  together,  then  place  the  test  skein 
"rose"  2  feet  from  the  rest  of  the  colors,  and  have 
the  candidate  being  examined  select,  as  before,  all 
the  colors  that  look  to  him  like  the  "rose"  skein,  and 
record  the  results  as  for  "light-green"  skein. 

No  names  should  be  mentioned  in  connection  witli 
any  colof  in  the  .-ihove  worsted  tests,  which  should  be 
based  oilI\  on  :i  coinparison  of  colors. 

If  the  candidate  for  employment  being  exammed 
selects  as  looking  like  the  gi'een-test  skein  any  of  the 


78 


KECOMMENDATIONS   OF    COMMITTEE   ON    HEALTH    AND   MEDICAL   RELIEF. 


reds,  or  as  looking  like  the  rose-test  skein  any  of  the 
greens,  the  candidate  shall  be  rejected.  If  a  candidate 
for  promotion  or  reexamination  makes  such  a  selection, 
full  report  shall  be  made  to  officer  to  whom  the  exam- 
iner reports. 

If  the  candidate  for  employment  selects  some  of 
the  grays  or  browns  as  looking  like  the  green-test 
skein  or  some  of  the  grays,  blues,  or  violets  as  looking 
like  the  rose-test  skein,  the  candidate  shall  be  rejected. 
If  a  candidate  for  promotion  or  reexamination  makes 
such  a  selection,  full  report  shall  be  made  to  officer 
to  whom  the  examiner  reports. 

The  selection  by  the  candidate  of  one  of  the  '  'colors 
of  confusion,"  as  matching  test  skein  light-green,  indi- 
cates color  blindness.  The  failure  to  do  this,  but  a 
manifest  disposition  to  do  so,  indicates  feeble  color 
perception;  making  correct  selection  to  match  test 
skein  "rose,"  having  failed  to  match  test  skein 
"light-green,"  incomplete  color  blindness  is  indicated. 
But  should  he  in  this  test  select  the  purple,  the  green, 
and  gi'ay  shades  also,  or  one  of  them,  compiete  green 
blindness  is  indicated.  The  test  with  skein  "red" 
(which  is  applied  only  to  those  who  are  color  blind  as 
to  green  or  red)  should  be  continued  until  the  candi- 
date under  examination  has  selected  the  specimens  of 
or  a  greater  part  of  the  skeins  belonging  to  this  color 
or  else  one  of  several  "colors  of  confusion."  In  this 
test  red  blindness  is  proven  by  the  selection,  besides 
the  red  shades,  of  olive  green  and  dark  brown  shades 
of  a  darker  quality  than  the  red-test  skein.  Green 
blindness  is  proven  by  the  selection  of  similar  confu- 
sion colors,  but  of  a  quality  lighter  than  the  red-test 
skein. 

RULES  GOVERNING  AURAL  STANDARDS. 

39.  Examinations  must  develop  ability  to  hear 
distinctly. 

Method  of  Testing. 

Place  the  candidate  at  a  distance  of  20  feet,  with  one 
ear  toward  the  examiner;  have  him  close  the  ear 
farthest  from  the  examiner  by  placing  the  finger  over 
it,  then  let  him  repeat  aloud  the  words  or  numbers 
spoken  in  a  conversational  tone  by  the  examiner  and 
record  the  distance  in  feet  at  which  they  can  be  re- 
peated correctly.  Have  him  turn  the  other  ear  toward 
the  examiner  and  repeat  the  test. 

Candidates  for  employment  will  not  be  accepted 
unless  able  to  hear  ordinary  conversation  the  full 
distance  of  20  feet. 

No  candidate  for  promotion  or  reexamination  can 
be  considered  to  have  sufficient  acuteness  of  hearing 
who  is  unable  to  repeat,  with  his  eyes  closed,  words  or 
numbers  spoken  in  an  ordinary  conversational  tone 
of  voice  at  a  distance  of  10  feet. 

Note. — The  following  may  be  used  if  desired:  A 
ratchet  acoumeter. 


PHYSICAL    DEFECTS    THAT     DISQUALIFY    FOR 
SERVICE. 

•  40.  A  careful  record  shall  be  made  of  any  physical 
defects  that  would  impair  the  usefulness  of  an  appli- 
cant for  service,  or  that  may  be  aggravated  by 
service,  or  that  would  contribute  to  the  prolongation 
of  disability  in  case  of  injury. 

41.  Among  the  disqualifying  defects  are  the  fol- 
lowing: 

Medical  and  Physical. 

Diabetes,  nephritis,  nephrolith,  pyelitis,  acute  and 
clu-onic  cystitis,  lithuresis,  valvular  heart  disease, 
tuberculosis,  active  and  arrested,  evidences  of  brain, 
cord,  and  spinal  nerve  disease,  epilepsy,  incapacitating 
heptatic  diseases,  venereal  diseases,  acute  and  chronic, 
objectionable  skin  diseases,  defective  vision,  color 
blindness,  trachoma,  or  any  other  eye  disease  that 
affects  or  will  affect  vision,  deafness,  chronic  otitis 
media. 

Surgical. 

Loss  of  thumb  or  loss  of  two  fingers  on  one  hand. 

Loss  of  arm,  leg,  or  hand. 

Varicose  veins  of  both  legs  or  marked  varicosity  in 
one  leg. 

Phlebitis,  hernia,  orchitis,  epididymitis,  hydrocele, 
undescended  testicle,  malignant  tumor,  appendicitis, 
chronic  and  recurrent,  skull  fracture  followed  bj'  head 
symptoms,  spinal  injuries,  spinal  curvature,  severe 
injuries  of  the  back,  ileo-sacral  sprain,  aneurism,  bone 
necrosis,  acute  and  clu-onic  periostitis,  synovitis,  float- 
ing cartilage,  impaired  mobility  of  joints  which 
incapacitates. 

42.  Applicants  for  service  whose  blood  pressure  is 
over  150  systolic  and  who  have  no  other  disqualifying 
physical  defects  may  be  given  the  privilege  of  another 
examination,  but  shall  not  be  accepted  for  service 
pending  the  time  in  which  he  takes  his  second  exam- 
ination, nor  shall  he  be  accepted  if  his  systolic  pressure 
continues  at  150  or  over. 

43.  Employees  in  train  service  or  holding  other 
positions  in  any  manner  connected  with  the  operation 
of  trains,  or  who  by  nature  of  their  employment  might 
because  of  sudden  physical  incapacity  endanger  the 
lives  of  fellow  employees  or  others,  who  on  examina- 
tion for  promotion  or  when  periodically  examined  are 
found  to  have  a  blood  pressure  of  over  175  and  less 
than  200  systolic  shall  be  kept  under  observation. 

44.  Employees  in  train  service  or  holding  othei' 
positions  in  any  manner  connected  with  the  operation 
of  trains,  or  who  by  nature  of  their  employment  might 
because  of  sudden  physical  incapacity  endanger  the 
lives  of  fellow  employees  or  others,  who  on  examina- 
tion for  promotion  or  when  periodicall}^  examined  are 
found  to  have  a  blood  pressure  of  200  systolic  or  over 
shall  be  held  out  of  service  pending  further  physical 
examination. 


RECOMMENDATIONS    OF    (HJMMITTKE    ON    KEALTH    AND    MI'.DICAL   KELIEF. 


79 


HEIGHT,      WEIGHT,      AND      CHEST      MEASUREMENT 
STANDARDS. 

45.  Applicants  for  service  wiio  on  (\vaniination 
present  the  following  conditions,  if  otherwise  mentally 
and  physically  fit,  shall  be  unconditionally  accepted 
for  general  railroad  service:  (a)  Those  who  fall  within 
the  accepted  standards  (A)  or  minimum  requirements 
(B)  for  height,  weight,  and  chest  measurement  given 
in  accompanying  tables.  (/;)  Those  whose  weight  is 
greater  than  the  standards  indicated  for  height,  pro- 
vided the  overweight  is  not  so  excessive  as  to  interfere 
with  the  performance  of  duties  connected  with  the 
railroad  service  applied  for. 

46.  Applicants  for  service  who  on  examination  are 
found  to  present  conditions  not  within  the  accepted 
measurements  for  weight  and  chest  circumference  and 
mobility  given  in  the  table,  who  are  otherwise  mentally 
and  physically  fit,  may  be  accepted  for  selected  rail- 
road service.  But  no  applicant  shall  be  accepted 
whose  weight  is  less  than  110  pounds.  This  rule  does 
not  apply  to  applicants  for  certain  classes  of  service 
whose  minimum  age  limit  is  under  18  years. 

47.  Table  of  standard  accepted  measurements  of 
height,  weight,  and  circumferance  of  chest. 

A.  Standard  accepted  m.easurements . 


Height. 

Weight. 

Chest  measurement. 

.A.t  ex-, 
piration. 

Mobility. 

120 
120 
120 
124 
128 
130 
132 
134 
141 
148 
155 
162 
169 
176 
183 
190 
197 
204 
211 

31 
31 
31 
31 
32 
32 
32i 
33' 
331 
33* 
34 
34i 
34J 
35J 
36i 
363 
371 
.371 
381 

61 

64   ... 

66 

67 

68 

69-      . 

2l 

71 

25 

72 

r 

73 

74 

76 

77 

78 

4 

B.  The  following  variations  from  tJie  standard  sTiovm 
in  column  A  are  permissible  when  the  applicant  is  active, 
has  firm  muscles,  and  is  evidently  vigorous  and  healthy. 


Weight. 

Chest  measurement. 

Height. 

pt'atto.    Mobility. 

110 
110 
110 
116 
120 
120 
120 
120 
121 
124 
128 
133 
13S 
143 
148 
1.55 
161 
168 
175 

61 

63 

64... 

66 

301  ,                2 

68 

.303                   2 

69... 

311  '                2 

71 .       . 

321 
32} 
33* 
341 
343 
351 
35} 

74 

76 

Di  reel  loan  for  lakin./j  height. — Use  a  board  at  leafil  2  in'-hf«  wifl<;  by 
SO  inrhos  long,  placed  vortifally,  and  carpfiilly  jfradiiatfd  lo  orio- 
quarler  inch  helween  oS  inches  from  the  floor  and  the  tof)  end. 
Oljtain  the  height  by  placing  horizontally  in  lirni  contact  with  the 
top  of  the  head  and  against  the  measuring  rod  an  a<-curately  scjuared 
board  of  about  (i  by  li  by  2  inches  -beet  permanently  attached  to 
graduated  boai'd  by  a  long  cord.  The  applicant  should  stand  erect 
with  l)ack  to  the  graduated  board,  eyes  .straight  to  the  front. 

Exhibit  F. 

SURVEY  AND  RECOMMENDATIONS  CONCERNING 
THE  CONTROL  OF  MALARIAL  FEVER. 

The  committee  visited  a  number  of  malarial  regioiuj 
ill  the  Southern  States  and  found  embankments  with- 
out adequate  culverts  impeding  the  natural  flow  of 
waters;  borrow  pits  created  many  stagnant  pools: 
and  poorly  maintained  lateral  drains:  these  conditions 
offered  favorable  opportunities  for  the  breeding  of 
Anopheles  mosquitoes,  wluch  are  directly  concerned 
in  the  transmission  of  malaria. 

Much  work  to  eliminate  these  c(jnditioiis  has  already 
been  done  on  the  St.  Louis-Southwestern  and  Louis- 
ville &  Nashville  Railroads.  Figures  were  given  the 
committee  b}^  railroad  ofRcials  at  Texarkana  which 
indicated  that  the  incidence  of  malaria  and  the  sick 
rate  at  the  railroad  hospital  at  Texarkana,  was 
greatly  reduced  by  the  antimalarial  measures  carried 
out.  In  some  instances  it  is  estimated  this  reduction 
has  reached  75  per  cent. 

In  view  of  the  results  wliich  have  alreadv  been 
acliieved,  it  is  apparent  that  the  control  of  malarial 
ferer  is  not  only  humanitarian  but  is  highly  profitable 
for  the  railroads.  The  committee  recommended  that 
in  territories  in  which  malaria  occurs,  the  railroads 
make  a  special  effort  to  cooperate  with  Government 
officials  to  reduce  malarial  mosquito  breeding. 

The  measures  employed  by  the  St.  Louis-South- 
western Railway  are  especially  commended  and  the 
committee  believes  their  plan  is  a  good  model  to 
follow. 

It  is  of  interest  to  mention  there  was  reported  in 
a  recent  number  of  the  United  States  Public  Health 
Service  reports  that  over  7,000  new  cases  of  malaria 
occurred  in  the  State  of  Louisiana  in  the  month  of 
May,  1919.  Judging  by  the  statemeiits  of  the  surgeons 
of  the  Illinois  Central  Railroad  Hospital  at  New 
Orleans,  it  is  a  reasonable  assumption  that  a  large 
percentage  of  these  cases  occurred  among  railroad 
employees.  Similar  conditions  probably  prevail  in 
other  States  in  wliich  malaria  occurs.  The  railroad 
officials  in  regions  in  wliich  malaria  has  been  reported 
are  in  favor  of  carrying  out  measures  to  combat  it. 
E.xpcricncc  so  far  has  shown  that  breeding  places  need 
only  l)e  eliminated  within  several  hundred  yards  of 
human  habitation. 


80 


RECOMMENDATIONS   OF    COMMITTEE   ON    HEALTH   AND   MEDICAL  BELIEF. 


Exhibit  G. 

SEPARATION       OF       CLAIMS       AND       SURGICAL 
DEPARTMENTS. 

It  would  almost  seem  needless  to  coiTLment  on  this 
recommendation,  except  to  say  that  a  number  of 
surgical  departments  are  directly  under  the  control 
of  and  surgeons  appointed  by  the  claims  or  legal 
departments;  and  in  consequence  the  doctor  is  valued 
not  so  much  because  of  his  ability  or  skill  but  because 
he  has  h  capacity  to  handle  employees  from  a  claims 
standpoint. 

iSix  of  the  regional  directors  have  expressed  their 
concurrence  in  the  views  of  the'  committee;  one  has 
opposed  it — a  letter  of  explanation  was  written  in 
reply  to  his  objections  June  13,  1919,  and  no  further 
comment  has  been  received  from  him. 

In  view  of  the  fact  that  six  of  the  regional  directors 
have  concurred  in  the  recommendation  and  possibly 
only  one  is  opposed,  it  is  recommended  that  the  sepa- 
ration of  the  claims  and  surgical  departments  on  all 
railroads  be  carried  into  effect. 

Exhibit  H. 

GRANTED  PRIVILEGE  OF  TRIP  TRANSPORTA- 
TION TO  RAILWAY  LOCAL  SURGEONS  TO 
ATTEND  MEDICAL  AND  SURGICAL  MEET- 
INGS   AND    CLINICS, 

Trip  transportation  for  local  surgeons  has  been 
granted  over  so-called  foreign  lines  in  order  that  they 
might  attend  medical  and  surgical  meetings  and  clinics. 

Recommendation  was  based  on  the  opinion  that 
local  surgeons  should  be  given  opportunity  to  advance 
their  knowledge  and  thereby  increase  their  efficiency 
in  railroad  service. 

Local  surgeons  are  at  this  time  taking  advantage  of 
the  privilege,  and  the  committee  feels  that  the  favor- 
able action  of  the  United  States  Railroad  Adminis,- 
tration  by  giving  opportunity  to  railroad  surgeons  to 
keep  in  touch  with  the  latest  methods  in  surgery  and 
medicine  will  be  of  greatest  advantage  to  all  con- 
(^erned. 

Exhibit  I. 

SURVEY  OF  INSPECTION  OF  REST  HOUSES 
WITH  RECOMMENDATIONS. 

Feeling  it  most  essential  that  men  in  train  service 
should  obtain  proper  rest  and  accommodations  while 
at  terminal  points  away  from  home,  and  that  rest 
rooms,  sleeping  quarters,  and  feeding  places  where 
furnished  for  this  purpose  would  probably  be  accepted 
by  the  employees  as  a  standard  of  living  conditions 
satisfactorj^  to  the  railroads,  the  committee  made 
recent  inspection  of  rest  houses  on  several  of  the  rail- 
roads, eastern  territory,  taking  it  for  granted  that 
this  would  give  it  the  opportunity  to  inspect  the  best. 
The  inspection  included  also  railroad  YMCA's. 


We  found  the  run  of  rest  houses  were  placed  more 
because  of  convenience  to  work  than  with  the  view  of 
obtaining  cleanliness,  fresh  air,  freedom  from  noise, 
etc.  In  the  main,  while  the  buildings  were  not  placed 
to  best  advantage,  we  found  them  capable  of  being 
made  fairly  comfortable.  The  maintenance  with 
exception  of  very  few  instances  was  next  to  deplorable. 
As  the  result  of  our  inspection  we  submit  the  follow- 
ing observations  and  recommendations: 

1.  The   surgical   and   medical   departments  of   the 
railroads  should  be  charged  with  the  absolute  respon- 
sibility of  maintaining  proper  sanitary  and  cleanly 
j  conditions,  and  the  railroads  should  insist  upon  regu- 
I  lar    inspections    at    frequent    intervals    by    medical 

inspector. 
;  2.  Too  much  stress  can  not  be  laid  upon  the  ueces- 
j  sity  of  selecting  an  intelligent,  active  janitor,  with 
sufficient  help  to  keep  rest  houses  clean  and  whole- 
some. He  should  be  responsible  to  the  medical 
inspector.  (In  our  opinion  this  is  not  a  pensioner's 
job.) 

3.  Clean    towels,    clean    bedding,    soap — in    ample 

I  quantities  should  be  supplied.     (Note. — Instructions 

■  generally  found  were  to  the  effect:     "That  bed  linen 

i  must  be  changed  when  necessary."     This  was  left  to 

i  the   judgment  of   the   janitor  in   control.     In   some 

instances  it  was  changed  every  two  or  three  days,  in 

j  other  instances  weekly,  and  again  at  longer  periods.) 

;       4.  Sleeping  quarters  shall  be  kept  quiet  and  the 

calling  system  so  cared  for  that  the  men  needed  are 

called. 

5.  For  general   sanitary   arrangements   and   main- 
tenance,  see  set  of  rules  and  regulations  also  sub- 
j  mitted. 

^  6.  Inspection  of  kitchens  and  refrigerators  and 
manner  in  which  food  was  handled  ranged  from  fair 
to  very  bad. 

7.  The  committee  does  not  favor  the  dormitory 
system  of  sleeping  quarters.  It  is  difiioult  to  call  men 
without  waking  other  sleepers.  One  or  two  noisy 
individuals  can  distrub  a  whole  room. 

We  do  not  believe  there  is  any  advantage  to  be 
gained  from  the  standpoint  of  better  ventilation  and 
light.  For  your  information,  the  hospitals  are  grad- 
ually eliminating  the  largeward  system. 

8.  The  committee  believes  that  unless  the  rest 
rooms,  sleeping  c^uarters,  and  restaurants  in  general 
are  kept  in  better  condition  than  most  of  those  we 
saw,  that  the  railroads  would  do  well  to  discontinue 
the  practice  where  possible.  If,  on  the  other  hand, 
cleanliness  and  high  standards  are  maintained  and 
respect  for  reasonable  rules  and  regulations  is  insisted 
upon,  we  believe  the  outlay  will  bring  a  fair  return, 
and  if  maintained  in  manner  recommended,  will  cer- 
tainly remove  one  source  of  irritation  that  at  present 
time  there  is  considerable  justification  for. 


RECOMMENDATIONS   OF    COMMITTEE   ON    HEALTH   AND   MEDICAL   RELIEF. 


81 


Exhibit  J. 

SURVEY  AND  RECOMMENDATIONS  REGARDING 
PRACTICE  OF  LAYMEN  BEING  USED  TO 
MAKE  VISION,  HEARING,  AND  COLOR  EX- 
AMINATIONS   OF    RAILROAD    EMPLOYEES. 

In  making  a  general  survey  of  various  railroads 
under  jurisdiction  of  the  United  States  Kailroad 
Administration  we  have  found  to  date  that  a  number 
of  roads  have  laymen  conducting  examinations  on 
eyesight,  hearing,  and  colors,  and  a  few  require  no 
examination  on  eyesight,  hearing,  and  colors.  A 
review  shows  the  unanimous  opinion  of  chief  surgeons, 
and  also  experts  not  associated  vdth  railroad  service 
that  such  practice  is  considered  unsafe  and  should 
be  discontinued. 

While  the  committee  does  not  wish  to  convey  the 
impression  that  a  layman  could  not  be  trained  to  make 
these  examinations  safely,  we  believe  that  train- 
masters, chief  despatchers  and  other  laymen  making 
examinations  are  so  occupied  by  their  important 
duties  that  they  do  not  have  the  opportunity  to 
obtain  the  technical  knowledge  which  is  actually 
required  to  make  these  examinations  properly.  Nor 
can  we  understand  the  advisability  of  having  these 
laymen  undertake  the  necessary  stud}^  when  a  com- 
petent physician  is  always  available  for  this  work. 
It  occurs  to  us  that  trainmasters  and  chief  despatchers 
who  may  be  required  to  make  investigations  of  train 
accidents  might  be  placed  in  a  very  embarrassing 
position  if  it  \yeve  found  that  an  engineman  whom 
they  had  jjassed  as  satisfactory  on  colors  had  caused 
a  wreck  as  a  result  of  color  deficiency. 

Finally,  it  is  the  opinion  of  the  committee  that  the 
practice  is  certainly  more  likely  to  leaa  to  error,  and 
it  would  appear  it  is  the  duty  of  railroads  to  reduce 
to  a  minimum  all  possible  chances  of  error. 

Therefore,  we  recommend  examinations  on  vision, 
hearing,  and  colors  be  made  by  competent  medical 
men. 

Summary  of  replies  from  regional  directors  on  this 
subject  follows: 

Eastern  Region. — Mr.  Hardin  advises  that  canvass 
of  the  Eastern  Region  indicates  considerable  number 
of  roads  have  been  conducting  color  examinations  by 
laymen  with  entirely  satisfactory  results;  that  these 
laymen  who  are  usually  trainmasters  or  their  assist- 
ants, or  on  the  larger  roads,  a  man  assigned  for  this 
purpose,  are  qualified  by  the  company  oculist  and 
are  provided  with  necessary  equipment;  and  as  they 
arc  constantly  conducting  these  exanainations  they 
naturally  becone  quite  proficient. 

In  this  connection,  Mr.  Hardin  takes  exception  to 
theattitudeof  theCommittee;  hefeels  that  as  these  lay- 


men havebeen  most  carefully  trained,  it  is  a  serious  mat- 
ter to  make  a  charge  of  this  kind  in  the  records  without 
supporting  data,  and  asks  if  Dr.  Dunott  can  give  any 
facts  in  the  way  of  accidents  or  other  incidents  which 
warrant  liis  statement. 

Allegheni/  Rcf/ion. — Mr.  Markham  states  that  on  the 
principal  lines  in  his  region  all  examinations  for  63-0- 
sight,  color  sense,  and  hearing  are  made  by  medical 
examiners  who  are  qualified  physicians. 
.  Pocethontos  Eefjinn.- — Mr.  Maher  advises  that  .vith 
the  exception  of  the  Chesapeake  and  Ohio  of  Indiana 
the  roads  in  his  region  have  been  conducting  these 
examinations  through  trainmasters,  etc.,  and  that  the 
results  have  been  reasonably  good.  He  recommends, 
however,  that  such  examinations  be  conducted  by 
the  medical  examiners  of  the  relief  and  pension 
department  on  roads  having  such  an  organization 
and  by  the  company  physicians  on  lines  where  no 
relief  or  pension  department  exists,  as  he  feels  that 
this  will  result  in  less  liability  of  error.  The  Indiana 
law  requires  employees  entering  railroad  sei"vice  to 
undergo  phj'sical  examination  and  secure  certificates 
from  a  physician.  These  examinations  include  vision, 
color  perception,  etc. 

Southern  Region. — ^Mr.  Winchell  states  that  it  is 
the  practice  on  railroads  in  his  region  to  have  such 
examinations  conducted  by  examining  surgeons  or 
oculists,  and  he  considers  it  desirable  that  the  present 
practice  be  continued. 

Northwesterrt  Region.  -Mr.  Aishton's  report  shows 
that  out  of  4.3  roads,  26  of  them  have  color  sense  exam- 
inations conducted  by  a  licensed  physician,  9  by 
laymen,  and  on  8  smaller  lines  no  color  tests  are 
required.  Mr.  Aishton  personally  feels  that  exam- 
ination of  color  sense  should  be  conducted  by  duly 
qualified  physicians  but  does  not  believe  there  is  anj' 
real  justification  for  making  any  change  in  practices 
existing  on  some  lines. 

Central  Western  Region. — Advice  from  Mr.  Holden 
is  that  the  majority  of  Federal  and  general  managers 
of  roads  in  his  region  favor  examinations  of  this  nature 
being  conducted  b\  trained  medical  examiners. 

Soutliwestern  Region. — With  two  exceptions  (Litch- 
field and  Madison  and  Terminal  Eailroad  Association) 
these  examinations  are  conducted  by  qualified  physi- 
cian or  oculist  on  all  roads  in  this  region.  In  Mr. 
Bush's  judgment  this  is  the  desirable  method,  and  he 
aavises  that  instructions  have  been  issued  to  Terminal 
Manager  Johnson  that  future  examinations  on  the 
Litchfield  and  Madison  and  Terminal  Eailroad  Asso- 
ciation should  be  made  by  a  qualified  physician  or 
oculist. 

Note. — ^The  committee  believes  that  the  field  test  on 
colors  is  unsatisfactory  and  liable  to  many  errors 
and  should  be  discontinued. 


g2 


RECOMMENDATIONS   OF   COMMITTEE    (3n    HEALTH   AND    MEDICAL   RELIEF. 


Exhibit  K. 
FIRST  AID. 

Committee  examined  a  large  number  of  iirst-aid  kits 
and  gave  the  whole  matter  special  study.  As  a  result 
of  this  study,  the  f ollowmg  simple  kit  was  evolved : 

A  black  Japanned  tin  box  with  beaded  edge  so  that 
the  cover  would  fit  tightly  and  do  away  with  the  neces- 
sity of  a  hasp  and  staple  to  fasten  it;  size  8i  inches 
long,  5 1  inches  wide,  and  4  inches  deep. 

The  contents  would  be — 

18  sterilized  finger  dressings,  each  in  separate  en- 
velope suitably  printed  in  accordance  with 
specifications. 
12  large  dressings,  each  in  separate  envelope  suit- 
ably printed  in  accordance  with  specifica- 
tions. 

3  triangular  bandages. 

1  spool  oxide  of  zinc  adhesive  plaster  1  inch  by 
5  yards.  • 

5  small  requisition  cards. 

1  instruction  folder. 

The  total  cost  would  be  11.95  net  per  box. 
The  cost  is  based  on  estimate  of  5,000  outfits. 
The  costs  of  the  individual  items  are  as  follows : 
The  tin  box  with  outside  label  and  inside  label  on 

cover each. .     43 

18  finger  dressings,  3  cents  each 54 

12  large  dressings,  5  cents  each 00 

3  triangular  bandages,  8  cents  each ,. .     24 

1  spool  adhesive  plaster eacli . .     12 

5  requisition  cards 1 

1  instruction  folder 1 

The  above  description  of  box  and  contents  with  esti- 
mate of  cost  submitted  by  Seabur}^  &  Johnson,  59-61 
Maiden  Lane,  New  York  City. 

Below  is  given  estimate  cost  of  a  stronger  and  easier 
carried  box  at  a  small  additional  cost,  submitted  by 
American  Can  Co.,  Oak  and  Twenty-sixth  Streets, 
Baltimore,  Md.: 

Oblong,  hinge  cover  box,  double  seamed  bot- 
tom, body  beaded,  top  edge  of  body  hemmed,  size 
8^  inches  by  5-J  inches  by  Sxg-  inches  l)ody  height, 
hasp  on  cover  and  staple  on  body,  cover  decorated 
in  one  print  on  a  coat,  body  and  bottom  plain  coated 
all  inside  and  partitions  plain  coated,  with  oval 
wire  handle  in  center  of  cover.  In  lots  of  5,000 
at  .^516. 75  per  thousand. 
If  cover  is  decorated  on  inside  also  in  lots  of  5,000  at  .'J)522  per 
thousand  f.  o.  b.  Brooklyn,  N.  Y.,  subject  to  1  per  cent  cash  dis- 


count 10  days  from  date  of  invoice  30  days  net.    There  will  be  a 
charge  for  special  preparation  of  engraving  on  the  initial  order. 

Estimate  cost  of  first-aid  kit  submitted  by  Johnson 
&  Johnson,  New  Brunswick,  N.  J.;  the  box  conforms 
to  the  description  given  of  box  in  estimate  of  Ameri- 
can Can  Co.;  similar  box  can  be  procured  from  Sea- 
bury  &  Johnson  at  a  small  additional  cost  over  box 
described  in  their  estimate: 

These  complete  outfits  we  quote  you  in  quantities 
of  5, 000  and  upward  for  reasonably  prompt  accept- 
ance at  §2.12  each. 
As  requested  by  you  we  also  quote  as  follows  the 
various  items  of  contents  as  well  as  the  empty 
case: 

Empty  container $0.  62 

18  small  gauze  pads,  folded  with  tape,  each 

in  sealed  envelope  at 33 

12  large  gauze  pads,  folded  with  tape,  each 

in  sealed  envelope  at 54 

3  triangular  bandages  with  pins,  sealed.  - .       .35 

1  spool  ZO  plaster  2  inches  by  5  yards 26 

6  requisition  cards 01 

1  first-aid  instruction  book 01 

In  addition  to  the  above  prices  the  metal  manufacturers  advise  us 
that  there  will  be  a  charge  of  $105  for  tools  used  in  the  manufacture  of 
these  cases,  but  that  this  amount  would  be  absorbed  by  them  in  the 
event  that  they  receive  an  order  for  the  tins  aggregating  25,000; 
therefore,  on  orders  for  less  than  25,000  it  will  be  necessary  for  us  to 
make  a  special  charge  of  .$105  in  addition  to  the  price  of  the  goods. 

It  is  our  recommendation  that  these  kits  be  placed 
on  all  passenger  trains,  engines,  cabooses,  in  shops,  and 
raih-oad  construction  camps. 

We  have  purposely  eliminated  all  drugs,  believing 
them  inadvisable  and  m  many  instances  dangerous.  ' 

If  our  suggestions  as  to  the  method  of  maintenance 
are  strictly  adhered  to,  and  the  employees  to  whom  the 
kits  are  turned  over  are  charged  with  the  responsibility 
of  seeing  the  kits  are  properly  maintaiaed  as  arranged 
for,  I  believe  you  will  find  that  this  will  counteract  one 
of  the  greatest  objections  that  has  been  raised  to  the 
first  aid  kit  in  railroad  service,  viz,  maintenance. 

It  is  our  recommendation  that  first-aid  package  now 
in  use  on  Pullman  cars  be  continued  as  "their first- 
aid  equipment;"  such  packages  are  satisfactory  for 
Pullman  cars  but  impracticable  for  cabooses,  engines, 
shops,  cars,  etc.,  due  to  the  fact  that  they  are  put  up  in 
a  pasteboard  carton,  which  is  easily  soiled  and  de- 
stroyed. 


o 


COLUMBIA  UNIVERSITY 

This  bQQ,k  is  due  on  the  date  indicated  below,  oi"  at  the 
expiration  of  a  definite  period  after  the  date  of  borrowing, 
as  provided  by  the  rules  of  the  Library  or  by  special  ar- 
rangement with  the  Librarian  in  charge. 

DATE  BORROWED 

DATE  DUE 

DATE  BORROWED 

DATE  DUE 

caB.ese.Mco 

EA615  Un3 

U.S.  Railroad  administration 


